@article{ref1,
title="Pediatric trauma patients with isolated grade III blunt splenic injuries may be safely managed without intensive care unit admission",
journal="Surgery",
year="2024",
author="Yuen, Sarah and Grigorian, Areg and Swentek, Lourdes and Qazi, Alliya and Jeng, James and Kuza, Catherine and Inaba, Kenji and Nahmias, Jeffry",
volume="ePub",
number="ePub",
pages="ePub-ePub",
abstract="BACKGROUND: Non-operative management is the standard of care for pediatric blunt splenic injury. The American Pediatric Surgical Association recommends intensive care unit monitoring only for grade IV/V blunt splenic injury; however, variation remains regarding this practice. We hypothesized that pediatric trauma patients with near-isolated grade III blunt splenic injuries admitted to a non-intensive care unit setting would have similar outcomes to those admitted to the intensive care unit. <br><br>METHODS: The 2017 to 2019 Trauma Quality Improvement Program database was queried for blunt pediatric trauma patients (≤16 years) with near-isolated grade III blunt splenic injuries. Patients with systolic blood pressure <90 mmHg or heart rate >90 were excluded. Pediatric trauma patients admitted to the intensive care unit were compared to non-intensive care unit admissions. The primary outcome was splenectomy. Bivariate analyses were performed. <br><br>RESULTS: Of 461 pediatric trauma patients with near-isolated grade III blunt splenic injuries, 186 (40.3%) were admitted to the intensive care unit. Intensive care unit patients were older than their non-intensive care unit counterparts (15 vs 14 years, P =.03). Intensive care unit and non-intensive care unit patients had a similar rate of splenectomy (0.5% vs 0.7%, P =.80) and time to surgery (19.7 vs 19.8 hours, P =.98). Patients admitted to the intensive care unit had a longer length of stay (4 vs 3 days, P <.001). There were no significant complications or deaths in either group. <br><br>CONCLUSION: This national analysis demonstrated that hemodynamically stable pediatric trauma patients with near-isolated grade III blunt splenic injuries admitted to the floor or intensive care unit had a similar rate of splenectomy without complications or deaths. This aligns with American Pediatric Surgical Association recommendations that pediatric trauma patients with grade III blunt splenic injuries be managed in non-intensive care unit settings. Widespread adoption is warranted and should lead to decreased healthcare expenditures.<p /> <p>Language: en</p>",
language="en",
issn="0039-6060",
doi="10.1016/j.surg.2024.03.040",
url="http://dx.doi.org/10.1016/j.surg.2024.03.040"
}