Prospective validation of an abbreviated bedrest protocol in the management of blunt spleen and liver injury in children

Abstract

An abbreviated protocol of 1 night of bedrest for grade I and II injuries and 2 nights for grade III or higher can be safely used, resulting in dramatic decreases in hospitalization compared with the current American Pediatric Surgical Association recommendations.

National trends in pediatric blunt spleen and liver injury management and potential benefits of an abbreviated bed rest protocol

“…Overall patient days saved were calculated using a 66% rate of prolonged hospital stay secondary to bedrest seen in a previous prospective observational study [5]. Weighted frequencies were used to provide a national estimate of days saved.…”

“…injuries and a two-day bedrest for injuries grade III or higher has been reported which safely reduced duration of hospitalization [4,5]. An abbreviated protocol has not been evaluated on a national level.…”

Handlebar injuries in children

“…Long periods of hospitalization were perceived as the prize for non-operative treatment and preservation of organs that otherwise might have been removed during the surgery. The short periods of hospitalization as recommended by Stylianos et al in 2000 [6] are questioned in the meantime by possibly even shorter stays as suggested by St. Peter et al in 2010 [22]. As the pendulum keeps swinging, the ideal compromise between patient safety and hospital resource utilization is not defined yet.…”

The effectiveness of non-operative treatment in high-grade liver and spleen injury

“…Also, in our study, the length of hospitalization, the duration of ICU stay and transfusion requirement were found to be significantly higher in patients with highgrade liver injury than those with low-grade liver injury. Despite St Peter SD et al [8,9] recommended abbreviated bed rest protocol regardless of grade, we think that the ICU followup is important on the first day to perform non-operative management effectively and to determine timing of surgical intervention correctly, particularly in patients with high-grade liver injury.…”

“…They observed that patients without clinical evidence of hemorrhage did not need surgery after two days of hospitalization. St Peter SD et al [8,9] presented two prospective studies to evaluate the reliability and efficacy of the protocol that they established by reducing the length of hospitalization. One night hospitalization in Grade I-II patients and two nights in higher grades were recommended.…”