Adherence to APSA activity restriction guidelines and 60-day clinical outcomes for pediatric blunt liver and splenic injuries (BLSI)

David M. Notrica, Lois W. Sayrs, Nidhi Krishna, Daniel J. Ostlie, Robert W. Letton, Adam C. Alder, Shawn D. St. Peter, Todd A. Ponsky, James W. Eubanks, David W. Tuggle, Nilda M. Garcia, Charles M. Leys, R. Todd Maxson, Amina M. Bhatia

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Abstract

Background: After NOM for BLSI, APSA guidelines recommend activity restriction for grade of injury + 2 in weeks. This study evaluates activity restriction adherence and 60 day outcomes. Methods: Non-parametric tests and logistic regression were utilized to assess difference between adherent and non-adherent patients from a 3-year prospective study of NOM for BLSI (≤ 18 years). Results: Of 1007 children with BLSI, 366 patients (44.1%) met the inclusion criteria of a completed 60 day follow-up; 170 (46.4%) had liver injury, 159 (43.4%) had spleen injury and 37 (10.1%) had both. Adherence to recommended activity restriction was claimed by 279 (76.3%) patients; 49 (13.4%) reported non-adherence and 38 (10.4%) patients had unknown adherence. For 279 patients who adhered to activity restrictions, unplanned return to the emergency department (ED) was noted for 35 (12.5%) with 16 (5.7%) readmitted; 202 (72.4%) returned to normal activity by 60 days. No patient bled after discharge. There was no statistical difference between adherent patients (n = 279) and non-adherent (n = 49) for return to ED (χ2 = 0.8 [p < 0.4]) or readmission (χ2 = 3.0 [p < 0.09]); for 216 high injury grade patients, there was no difference between adherent (n = 164) and non-adherent (n = 30) patients for return to ED (χ2 = 0.6 [p < 0.4]) or readmission (χ2 = 1.7 [p < 0.2]). Conclusion: For children with BLSI, there was no difference in frequencies of bleeding or ED re-evaluation between patients adherent or non-adherent to the APSA activity restriction guideline. Level of evidence: Level II, Prognosis.

Original languageEnglish (US)
JournalJournal of Pediatric Surgery
DOIs
StateAccepted/In press - Jan 1 2018

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Keywords

  • Abdominal trauma
  • Blunt trauma
  • Injury
  • Pediatric
  • Splenic injury

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

Notrica, D. M., Sayrs, L. W., Krishna, N., Ostlie, D. J., Letton, R. W., Alder, A. C., St. Peter, S. D., Ponsky, T. A., Eubanks, J. W., Tuggle, D. W., Garcia, N. M., Leys, C. M., Maxson, R. T., & Bhatia, A. M. (Accepted/In press). Adherence to APSA activity restriction guidelines and 60-day clinical outcomes for pediatric blunt liver and splenic injuries (BLSI). Journal of Pediatric Surgery. https://doi.org/10.1016/j.jpedsurg.2018.08.061