title: The use of an institutional pediatric abdominal trauma protocol improves resource use.
abstract: BACKGROUND
  A novel protocol to standardize the emergency center (EC) management of abdominal trauma in children was developed and implemented at our trauma center. The purpose of this study was to evaluate whether this protocol improved patient safety by decreasing unnecessary computed tomography (CT) radiation and improved quality of care by decreasing EC length of stay (LOS) and laboratory costs.
  
  
  METHODS
  We performed a prospective, longitudinal study of children who presented to the EC with a mechanism for abdominal trauma and received an abdominal CT scan from January 2011 to September 2014. Patients were divided into protocol periods: preimplementation (January 2011 to December 2011), Postimplementation 1 (January 2012 to August 2013), and Postimplementation 2 (September 2013 to September 2014). Outcome measures included protocol adherence, rates of clinically positive CT results, the EC LOS, and the cost of laboratory studies. χ and analysis of variance were used for statistical analysis.
  
  
  RESULTS
  During the study period, 117 patients in the preimplementation, 148 patients in the Postimplementation 1, and 56 patients in the Postimplementation 2 periods were identified. Protocol adherence improved from 70% to 82% (p = 0.11) from the Postimplementation 1 to Postimplementation 2 periods. The rate of positive CT scan results increased from 23% to 31% to 46% (p = 0.003) from preimplementation to Postimplementation 1 and Postimplementation 2, respectively. When the protocol was followed, the proportion of clinically significant scans was higher than when it was not followed (31% vs. 8%, p = 0.001). The EC LOS was unchanged (median [range], 271 minutes [16-1,039 minutes] vs. 233 minutes [40-1,396 minutes], p = 0.34). The median cost of laboratory studies remained the same from preimplementation to Postimplementation 1 ($166 [$0-$454] vs. $352 [$0-$448], p = 0.29) and decreased after the second protocol revision included an emphasis on laboratory work in Postimplementation 2 ($139 [$33-$426], p = 0.005).
  
  
  CONCLUSIONS
  The use of an institutional abdominal trauma management algorithm is an effective method of improving resource use by decreasing unnecessary CT scan use and laboratory costs.
  
  
  METHODS
  Economic analysis, level IV; therapeutic/care management study, level IV.
authors.affiliation: From the Division of Pediatric Surgery (S.C.F, A.A., B.J.N.-M.), Michael E. DeBakey Department of Surgery, and Division of Pediatric Emergency Medicine (D.D., D.C.), Department of Emergency Medicine, Baylor College of Medicine; and Trauma Services (D.D., D.C., B.J.N.-M.), Texas Children's Hospital, Houston, Texas.
authors.forename: Sara C
authors.initials: SC
authors.lastname: Fallon
authors.forename: David
authors.initials: D
authors.lastname: Delemos
authors.forename: Adesola
authors.initials: A
authors.lastname: Akinkuotu
authors.forename: Daniel
authors.initials: D
authors.lastname: Christopher
authors.forename: Bindi J
authors.initials: BJ
authors.lastname: Naik-Mathuria
mesh_terms: D000007:Abdominal Injuries / Q000175:diagnosis* / Q000628:therapy*; D002648:Child; D002985:Clinical Protocols; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D058996:Quality Improvement; D011829:Radiation Dosage; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data; D014193:Trauma Centers / Q000458:organization & administration*; D014949:Wounds, Nonpenetrating / Q000175:diagnosis* / Q000628:therapy*