Throwing out the “grade” book: management of isolated spleen and liver injury based on hemodynamic status

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

“…Despite several reports of the safety of shorter periods of observation and bedrest [3,4], the most widely used guidelines continue to be those published by the Trauma Committee of APSA [1,2]. Although these guidelines have been shown to be safe, there are several flaws that provide an opportunity for improvement.…”

“…Although widely used, these recommendations have not been universally used, and management based on hemodynamic status has been recommended and validated [3,4]. We previously reviewed our experience to examine the role of an abbreviated protocol for all patients with BSLI that could be safely used to reduce the resources utilized in the care of these patients [5].…”

Review of the evidence on the management of blunt renal trauma in pediatric patients

“…The length of bed rest has been the point of debate in the recent literature for spleen and liver injuries [88,89]. The period of bed rest for renal injury has not been well studied leading to wide variation of reported recommendations.…”

Diversity of the Definition of Stable Vital Sign in Trauma Patients: Results of a Nationwide Survey

“…Both base deficit and lactate concentration correlated with transfusion requirements; in addition, base deficit (BD) correlated with trauma score, and lactate correlated with the amount of hemoperitoneum. [29] Rixen et al have also performed a prospective, multi-center, observational study of 2,069 multiple trauma patients to evaluate the significance of BD. BD was associated with a significant decrease in systolic blood pressure, prothrombin time, amount of transfusion, and mortality.…”