J Trauma Acute Care Surg. 2023 Jan 16. doi: 10.1097/TA.0000000000003870. Online ahead of print.
ABSTRACT
BACKGROUND: The Arizona-Texas-Oklahoma-Memphis-Arkansas Consortium (ATOMAC) practice management guideline was created to standardize management of blunt liver or spleen injury across pediatric trauma centers. We describe our outcomes since guideline adoption at our institution and hypothesize that blunt liver or spleen injury may be managed more expeditiously than currently reported without compromising safety.
METHODS: A retrospective cohort study was conducted on patients <18 years presenting with BLSI from March 2016 to March 2021 at one participating center.
RESULTS: 199 patients were included. There were no clinically relevant differences for age, body mass index (BMI), or sex among the cohort. 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). Intensive Care Unit (ICU) utilization was 23% (n = 46). There was no statistically significant difference in median LOS among patients with isolated solid organ injuries, regardless of injury grade. There were no readmissions associated with non-operative management.
CONCLUSION: 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.
LEVEL OF EVIDENCE: IV, Therapeutic/Care management.
PMID:36649594 | DOI:10.1097/TA.0000000000003870
