The benefits of limiting scheduled blood draws in children with a blunt liver or spleen injury

J Pediatr Surg. 2020 Jul;55(7):1219-1223. doi: 10.1016/j.jpedsurg.2019.05.006. Epub 2019 May 16.

Abstract

Background: Nonoperative management protocols of blunt liver and spleen injury in children usually call for serial monitoring of the child's hemoglobin and hematocrit (H/H) at scheduled intervals. We previously demonstrated that the need for emergent intervention is triggered by changes in vital signs, not the findings of scheduled blood draws and changed our protocol accordingly. The current aim is to evaluate the safety of this change.

Methods: We performed a retrospective review of all children admitted following blunt liver or spleen injury during two periods; the historic cohort 1/09-12/13 and the protocol cohort 8/15-7/17. Data evaluated included the need for intervention, number of H/H checks, and outcomes.

Results: 330 children were included (216 historic; 114 protocol). Groups did not differ in percentage of male patients, injury severity score, or GCS. Median age in the historic cohort was younger than the protocol cohort (9 vs 12 years; p = 0.02). More children in the protocol group had a grade 5 injury (1% vs 9%; p < 0.0001). Groups did not differ in the number who required intervention or discharge disposition (including mortality). The protocol group had fewer H/H checks (median 5 vs 4, p < 0.0001); the two groups did not differ in their nadir H/H. The historic group had a longer median hospital length of stay (3 days vs 2, p = 0.0007).

Conclusions: Decreasing the number of scheduled blood draws following a blunt liver or spleen injury in children is safe. Additional benefits include a decrease in the number of blood draws and a decrease in length of hospital stay.

Study type: Cost-effectiveness.

Level of evidence: Level III.

Keywords: Blood draw; Blunt abdominal trauma; Liver laceration; Pediatric trauma; Serial; Spleen laceration.

MeSH terms

  • Adolescent
  • Child
  • Female
  • Humans
  • Injury Severity Score
  • Length of Stay / statistics & numerical data
  • Liver / injuries*
  • Male
  • Phlebotomy / statistics & numerical data*
  • Retrospective Studies
  • Spleen / injuries*
  • Wounds, Nonpenetrating / surgery*