Emergency Department, Inpatient, and ICU Clinical Pathway for Children with Blunt Abdominal Solid Organ Injury
Team Assessment
- History and Physical
- Labs
- Imaging
- CT with IV Contrast
- Delayed Images for ≥ Grade III Renal Injuries
Liver, Spleen, or Kidney Injury Confirmed by CT
- Use highest grade for multiple solid organ injuries
- Consult Urology for ≥ Grade III kidney injuries including any disruption of the collecting system
Improvement
No Improvement
Admit to Inpatient Unit
Admit to PICU
Change in
hemodynamics
hemodynamics
- Transfer to floor from PICU:
- Hemodynamically Stable
- and
- Hgb Stable without transfusion in last 24 hrs
Evidence
- External Validation of a Five-Variable Clinical Prediction Rule for Identifying Children at Very Low Risk for Intra-Abdominal Injury After Blunt Abdominal Trauma
- Non-operative Management of Solid Organ Injuries in Children: An American Pediatric Surgical Association Outcomes and Evidence Based Practice Committee Systematic Review
- Failure of Nonoperative Management of Pediatric Blunt Liver and Spleen Injuries
- Microhematuria as an Indicator of Significant Abdominal Injury
- Additional Evidence