Evidence-based guidelines for resource utilization in children with isolated spleen or liver injury

Purpose: This study is intended to resolve the disparity and reach consensu s on issues regarding the treatment of children with isolated spleen or liv er injuries. To maximize patient safety and assure efficient, cost-effectiv e utilization of resources, it was essential to determine current practice. Methods: Data from the case records of 856 children with isolated spleen or liver injury treated at 32 pediatric surgical centers from July 1995 to Ju ne 1997 were collected. The severity of injury was classified by computed t omography (CT) grade and the data analyzed for intensive care unit (ICU) st ay, length of hospital stay, transfusion requirement, need for operation, p re- and postdischarge imaging, and restriction of physical activity. Patien ts with grade V injuries (2.8%) were excluded leaving 832 patients for deta iled review. These data and available literature were analyzed for consensu s by the 1998 APSA Trauma Committee. Results: Resource utilization increased with injury severity (see Table 2). Based on the data analysis, literature search, and consensus conference, t he authors propose guidelines (see Table 3) for the safe and optimal utiliz ation of resources in routine cases. It is important to emphasize that no r ecommendation falls outside the 25th percentile of current practice at part icipating centers. Conclusions: Diversity of treatment, with attendant variation in resource u tilization in children with isolated spleen and fiver injury of comparable severity is confirmed. This ana lysis has stimulated a prospective outcomes study with the objective of validating the evidence-based guidelines propo sed. This evidence-based study design can bring order and conformity to pat ient management resulting in optimal utilization of resources while maximiz ing patient safety. J Pediatr Surg 35:164-169. Copyright (C) 2000 by W.B. S aunders Company.