Application of the APSA evidence-based guidelines for isolated liver or spleen injuries: a single institution experience

Abstract

Purpose: In 1998, the American Pediatric Surgical Association (APSA) recommended evidence-based guidelines for the management of hemodynamically stable patients with isolated liver or spleen injuries. A clinical practice guideline (CPG) was developed using the APSA guidelines. This study analyzes the impact of the CPG on the care of these children in a single institution.

Methods: Patients treated with the CPG between September 1998 and June 2002 were compared with a similar cohort admitted from February 1992 to October 1997, before the CPG was instituted. Groups were analyzed for age, computerized tomographic organ injury grade, hematocrits obtained, Injury Severity Score (ISS), length of intensive care unit (ICU) and hospital stay, follow-up imaging studies performed, and outcome.

Results: CPG patients had a shorter ICU length of stay (0.4 +/- 0.6 v 1.4 +/- 0.6 days; P <.001), shorter hospital stay (3.8 +/- 1.2 v 7.2 +/- 1.4 days; P <.001), fewer hematocrits obtained (4.7 +/- 2.2 v 9.2 +/- 3.1; P <.001), and fewer follow-up imaging studies (0.3 +/- 0.4 v 2.1 +/- 1.1; P <.001). One patient in the CPG group was readmitted for delayed hemorrhage. No urgent operations were performed in either group.

Conclusions: Application of an APSA-based CPG resulted in decreased length of ICU stay, decreased hospital stay, and decreased resource utilization without any noted effect on outcome.