Closing the Gap in Care of Blunt Solid Organ Injury in Children.
Cross-sectional data of pediatric blunt solid organ injury (SOI) demonstrates higher rates of non-operative management and shorter lengths of stay (LOS) in pediatric (PTC) vs adult (ATC) or dual (DTC) trauma centers. Recent iterations of guidelines (McVay 2008, St Peter 2011, ATOMAC 2015) have emphasized physiologic parameters rather than injury grade in clinical decision making, improving resource allocation and decreasing LOS. We sought to evaluate how these guidelines have influenced care.The National Trauma Data Bank (2007-2016) was queried for isolated spleen and liver injuries in patients less than 19 years old. Linear regression, odds ratio, and chi-squared test were used to determine significance between operative intervention or LOS among different trauma center types and grade of injury.A total of 55,036 blunt spleen or liver injuries were identified. Although operative rates decreased in ATCs over time (p=0.037), patients treated at ATCs or DTCs continued to demonstrate higher odds ratios of operative intervention (OR 4.43 and 2.88, respectively) compared to PTCs. Mean LOS decreased by 1.52 (p<0.001), 0.49 (p=0.26), and 1.31 (p=0.05) days at ATC, DTC, and PTC to 6.43, 6.68, and 5.16 days. Improvement in LOS for ATCs was distributed across injury Grades I, II, and IV, while there was no correlation amongst PTCs for Injury Grade.Despite over a decade of guidelines in pediatric SOI supporting non-operative management and accelerated discharge pathways based on physiologic parameters, rates of operative intervention remain much higher in ATCs versus PTCs and all centers appear to fall short of consensus guidelines for discharge.Epidemiological Study, Level III.