Emergency Department, Inpatient, and ICU Clinical Pathway for Children with Blunt Abdominal Solid Organ Injury
- Review
- History and Physical
- ED/Trauma Labs
- CT with IV Contrast
- Delayed Images for Renal Injuries
- Liver, Spleen, or Kidney Injury confirmed by CT
- Determine Grade
- Consult Urology for > 3 grade kidney injuries including any disruption of the collecting system
- If multiple solid organ injuries use highest grade
- Hemodynamically stable AND
- Injury Grade ≤ IV AND
- Admission Hgb ≥ 7
- Hemodynamically stable AND
- Injury Grade V OR
- Admission Hgb ≤ 7
- Improvement with isotonic
- fluid administration and/or
- PRBC transfusion
Yes
No
Admit to Inpatient Unit
Admit to PICU
Change in hemodynamics
- Transfer to floor from PICU IF:
- Hemodynamically stable AND
- Hgb stable without transfusion in last 24 hrs
Posted: February 2014
Revised: September 2021
Authors: D. Perks, CRNP, MSN; M. Nance, MD; J. Osipowicz, CRNP
Revised: September 2021
Authors: D. Perks, CRNP, MSN; M. Nance, MD; J. Osipowicz, CRNP
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
- More Evidence