Evidence-based guidelines for resource utilization in children with isolated spleen or liver injury

Stylianos, Steven

doi:10.1016/s0022-3468(00)90003-4

Cited by 306 publications

(231 citation statements)

References 18 publications

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“…Fresh frozen plasma was administered to these patients according to 1:1:1 massive transfusion protocol. This is in accordance with the rate that is used in a multicenter study (1). When compared to ATOMAC guidelines (Figure 1) (13), transfusion cutoff of 8 g/dL in the series is higher than the offered value 7 g/dL.…”

Section: Gmjsupporting

confidence: 85%

“…Regarding the spleen preservation, our results are better than the results of other series because none of the grade 3 or grade 4 patients experienced spleen loss (1,12). Spleen loss was observed in only one patient with a G5 injury and the patient needed an immediate splenectomy.…”

Section: Discussioncontrasting

confidence: 58%

“…It is 24 hours for G1 injuries and 96-120 hours for G5 injuries (1,2). In our study, mean hospital stay duration was 5.64 days and there were concomitant injuries in more than half of the patients.…”

Section: Gmjmentioning

confidence: 51%

“…The general approach to spleen trauma in children is conservative. Non-operative management (NOM) protocols (such as intensive care unit (ICU) stay, hospital stay, and imaging and activity restriction depending on the grade of the injury) have been proposed for spleen and liver injuries in children (1,2). Criteria for NOM protocol selection are mainly the absence of peritonitis signs and having a hemodynamically stable child.…”

Section: Introductionmentioning

confidence: 99%

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A Standardized Approach for Spleen Trauma in the Children

Embleton

User

Okur

et al. 2017

GMJ

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Aim: The aim of this study is to evaluate the results of pediatric blunt spleen trauma patients who were treated with a standard fluid protocol. Patients and Method: Children who were treated in a university hospital for blunt spleen trauma between 2012 and 2015 were included. Age, gender, mechanism of the injury, spleen injury scale, concomitant injuries, hemoglobin levels, thrombocytopenia and thrombocytosis, administration of blood and blood products, and hospital stay duration and results were evaluated. The fluid requirements of the stable children were calculated according to Holliday-Segar equation. The fluid intake of the children was adjusted so that the urine output was 1 ml/kg/h. Results: Totally 28 children who were at the age of 3-18 years were evaluated. Injury grade (G) was G1 in 3 patients, G2 in 12 patients, G3 in 10 patients, G4 in 2 patients, and G5 in 1 patient. There were no side effects related to the fluid protocol and the monitoring of the urinary output was helpful. Grade 5 patient needed an immediate splenectomy. Thrombocytosis was developed in four patients during the hospitalization and it suggested an impaired clearance of spleen in Grade 4 patients. Re-bleeding developed in one G3 patient after discharge. No mortality was observed. Conclusion: Our management protocol was successfully applied and spleen loss was observed only in a case of grade 5 injury. Adjusting the fluid volume according to the urinary output prevented volume overload and re-bleeding. Thrombocytosis may occur after severe splenic trauma and it should be carefully followed up. İdame sıvı, idrar çıkışı 1 ml/kg/sa olacak şekilde ayarlandı. Bulgular: Yaşları 3-18 yaş arasında toplam 28 çocuk çalışmaya dahil edildi. Yaralanma derecesi (G) 3 hastada G1, 12'sinde G2, 10'unda G3, ikisinde G4 ve bir hastada G5 idi. Sıvı protokolüne ait yan etki gözlenmedi. İdrar çıkışının monitorizasyonu yararlı bulundu. G5 hastaya hemen splenektomi yapıldı. Hastane yatış süresi içinde 4 hastada trombositoz ortaya çıktı, bunlardan ikisi, dalak klirensinin azaldığı düşünülen G4 yaralanması olan hastalardı. Bir G3 hastada taburculuk sonrasında kanama tekrarladı. Seride mortalite olmadı. Sonuç: Yaklaşım protokolümüz başarıyla uygulandı ve sadece G5 hastada dalak kaybı oldu. Sıvı gereksinimlerinin idrar çıkışına göre ayarlanması, sıvı yüklenmesini ve kanamanın tekrar başlamasını önledi. Ağır dalak yaralanmalarından sonra trombositoz ortaya çıkabilir ve dikkatle izlenmeyi gerektirir.

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Section: Gmjsupporting

confidence: 85%

Section: Discussioncontrasting

confidence: 58%

Section: Gmjmentioning

confidence: 51%

Section: Introductionmentioning

confidence: 99%

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A Standardized Approach for Spleen Trauma in the Children

Embleton

User

Okur

et al. 2017

GMJ

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“…The immunological consequences of splenectomy [5,6] and the realization that most splenic injuries stop bleeding spontaneously in the vast majority of cases created the impetus for nonoperative management, which is now the standard of care [7]. The current recommendation of bed rest equaling 1 day plus the grade of injury has recently been reviewed, and an attenuated protocol has been recommended for hemodynamically stable patients to facilitate concise utilization of health care resources [8].…”

Section: Discussionmentioning

confidence: 99%