Presenter Status
Fellow
Abstract Type
Research
Primary Mentor
Tolulope A Oyetunji
Start Date
10-5-2023 11:30 AM
End Date
10-5-2023 1:30 PM
Presentation Type
Abstract
Description
Background: The Arizona-Texas-Oklahoma-Memphis-Arkansas Consortium (ATOMAC) practice management guideline (PMG) was created to standardize management of blunt liver or spleen injury (BLSI) across pediatric trauma centers. Evaluations of institutional outcomes after its adoption remain scarce. We describe our outcomes since PMG adoption at our institution.
Objectives/Goal: The purpose of this study was to assess patient outcomes and resource utilization after implementation of this protocol. We hypothesized there is no difference in length of stay (LOS) or complications regardless of grade of isolated injuries to the liver or spleen. In addition, there is limited guidance on the management of concurrent injuries to both the liver and spleen and we hypothesize that these patients may be managed similarly, but the outcomes of LOS and resource utilization may not be comparable.
Methods/Design: An Institutional Review Board (IRB) approved retrospective cohort study was conducted on patients < 18 years presenting with blunt liver and/or splenic injuries from March 2016 to March 2021 at a single pediatric trauma center. We queried our institutional trauma database for all pediatric patients who were diagnosed with solid organ injury of the liver or spleen after blunt abdominal trauma. Subjects were excluded if the mechanism was penetrating, non-accidental trauma or diagnosis of solid organ injury was made at the time of trauma laparotomy and no imaging was obtained. Data were collected and managed using REDCap (Research Electronic Data Capture) software and analyzed using STATA (StataCorp 2017. Stata Statistical Software: Release 15. College Station, Tx: StataCorp LLC). Data summaries are expressed as medians with interquartile range and were compared using Mann–Whitney U test. A p-value <0.05 was considered statistically significant.
Results:199 patients were included. The median (interquartile range (IQR)) age was 10.9 (6.3, 14.8) years, 66% (n=130) were male, and the median injury severity score (ISS) was 14 (9, 19). Isolated splenic injuries 46% (n=91), and motor vehicle collisions (MVC) 41% (n=82) were the most common injury and mechanism, respectively. The overall median length of stay (LOS) was 1.2 days (IQR 0.45, 3.3) with those admitted to the floor staying for 1.0 (0.5, 1.9) day(s). Among the 23% (n=46) admitted to the Intensive Care Unit (ICU), median LOS was 6.5 (0.6, 15.7) days. In patients with isolated injuries, median LOS by injury grade (in days) were 0.4 (0.5, 4.2), 1 (0.5, 2.3), 1 (0.3, 1.7), 1.5 (0.6, 3.0), and 1.7 (0.9, 5.8) for grade 1-5, respectively. Three patients (1.5%) who required operative intervention due to hemodynamic instability and peritonitis with grade 5 liver injuries; all died. Three patients (1.5%) required angiographic embolization (AE) for splenic injuries. There were no readmissions after nonoperative management.
Conclusions: Our implementation of the ATOMAC guideline fosters high rates of non-operative management with low ICU utilization and LOS, while demonstrating safety in implementation, irrespective of injury grade.
MeSH Keywords
pediatric trauma; Liver; Spleen
Included in
Higher Education and Teaching Commons, Medical Education Commons, Pediatrics Commons, Science and Mathematics Education Commons, Surgery Commons, Trauma Commons
Institutional Outcomes Of Blunt Liver & Splenic Injury In The Atomac Era
Background: The Arizona-Texas-Oklahoma-Memphis-Arkansas Consortium (ATOMAC) practice management guideline (PMG) was created to standardize management of blunt liver or spleen injury (BLSI) across pediatric trauma centers. Evaluations of institutional outcomes after its adoption remain scarce. We describe our outcomes since PMG adoption at our institution.
Objectives/Goal: The purpose of this study was to assess patient outcomes and resource utilization after implementation of this protocol. We hypothesized there is no difference in length of stay (LOS) or complications regardless of grade of isolated injuries to the liver or spleen. In addition, there is limited guidance on the management of concurrent injuries to both the liver and spleen and we hypothesize that these patients may be managed similarly, but the outcomes of LOS and resource utilization may not be comparable.
Methods/Design: An Institutional Review Board (IRB) approved retrospective cohort study was conducted on patients < 18 years presenting with blunt liver and/or splenic injuries from March 2016 to March 2021 at a single pediatric trauma center. We queried our institutional trauma database for all pediatric patients who were diagnosed with solid organ injury of the liver or spleen after blunt abdominal trauma. Subjects were excluded if the mechanism was penetrating, non-accidental trauma or diagnosis of solid organ injury was made at the time of trauma laparotomy and no imaging was obtained. Data were collected and managed using REDCap (Research Electronic Data Capture) software and analyzed using STATA (StataCorp 2017. Stata Statistical Software: Release 15. College Station, Tx: StataCorp LLC). Data summaries are expressed as medians with interquartile range and were compared using Mann–Whitney U test. A p-value <0.05 was considered statistically significant.
Results:199 patients were included. The median (interquartile range (IQR)) age was 10.9 (6.3, 14.8) years, 66% (n=130) were male, and the median injury severity score (ISS) was 14 (9, 19). Isolated splenic injuries 46% (n=91), and motor vehicle collisions (MVC) 41% (n=82) were the most common injury and mechanism, respectively. The overall median length of stay (LOS) was 1.2 days (IQR 0.45, 3.3) with those admitted to the floor staying for 1.0 (0.5, 1.9) day(s). Among the 23% (n=46) admitted to the Intensive Care Unit (ICU), median LOS was 6.5 (0.6, 15.7) days. In patients with isolated injuries, median LOS by injury grade (in days) were 0.4 (0.5, 4.2), 1 (0.5, 2.3), 1 (0.3, 1.7), 1.5 (0.6, 3.0), and 1.7 (0.9, 5.8) for grade 1-5, respectively. Three patients (1.5%) who required operative intervention due to hemodynamic instability and peritonitis with grade 5 liver injuries; all died. Three patients (1.5%) required angiographic embolization (AE) for splenic injuries. There were no readmissions after nonoperative management.
Conclusions: Our implementation of the ATOMAC guideline fosters high rates of non-operative management with low ICU utilization and LOS, while demonstrating safety in implementation, irrespective of injury grade.
