Emergency Department, Inpatient, and ICU Clinical Pathway for Children with Blunt Abdominal Solid Organ Injury

Inpatient Unit Admission Guidelines

Failure of nonoperative management is uncommon (< 5 %) and is significantly associated with injury severity, pancreatic injury, and multiple organ system involvement
The need for operative intervention is typically determined within 12 hrs of the injury

	Grade I-II	Grades III-IV
Epic Admission Order Set	TraumaBluntAbdomen Grade I-II FLOOR	TraumaBluntAbdomen Grade III-IV FLOOR
Activity	Ad Lib	Bedrest with bathroom privileges until 24 hrs from injury then Advance activity as tolerated
Nutrition	Regular diet
Lab Tests	CBC q8hr until stable trend	CBC q8hr until stable trend and Consider 4-6 hrs post-ambulation
Lab Tests	LFTs, amylase, lipase, UA Repeat if previously abnormal
Vital Signs	Every 4 hrs
Monitoring	As needed	Continuous CR monitor and pulse oximetry for 24 hrs (Minimum)
Treatment and Procedures	Incentive spirometry Sequential compression device (if age appropriate)
Pain Management	Mild: acetaminophen (PO, PR) Moderate: oxycodone (PO) Severe: morphine (IV) NSAIDs may be utilized as second line for management of pain in hemodynamically stable children with Grade I-IV spleen and liver injuries, and Grade I-III kidney injuries without large or expanding hematoma
Consults	≥ Grade III and above renal injuries require a formal Urology consult Other consults as clinically indicated

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.