Nonoperative management of solid organ injuries in children results in decreased blood utilization

Background: The administration of blood products to injured children has be en recognized as a potential risk of nonoperative management. The purpose o f this study was to evaluate blood utilization in the management of solid o rgan injuries in pediatric blunt abdominal trauma victims. Methods: One hundred sixty-one children (less than or equal to 16 years old ) with solid organ injuries over an 8-year study period (1990 through 1997) were identified from the trauma registries at 2 urban regional trauma cent ers. Results: Mean age of the study patients was 7.9 +/- 0.4 years, 95 (59%) wer e boys, and their mean injury severity score (ISS) was 17.8 +/- 1.2. Patien ts were divided into 4-year study cohorts (1990 through 1993 and 1994 throu gh 1997) to examine changes in operative management and blood utilization. For each time period examined, those treated nonoperatively received fewer blood transfusions (46% v 9% and 44% v 13%, P < .05 by Fisher's Exact test) , and the hospital length of stay was shorter (12.3 +/- 2.1 v 5.0 +/- 0.7 a nd 7.8 +/- 1.9 v 4.2 +/- 0.4 days, P < .0001 by analysis of variance/Scheff e's) compared with the laparotomy cohort. Conclusions: The appropriate nonoperative management of injured children ac tually reduces the risks of receiving blood transfusion and decreases the l ength of hospital stay compared with aggressive operative intervention. Blo od transfusion should be reserved only for those injured children with soli d organ injuries who are hemodynamically unstable. Copyright (C) 1999 by W. B. Saunders Company.