Isolated Low-Grade Solid Organ Injuries in Children Following Blunt Abdominal Trauma: Is It Time to Consider Discharge from the Emergency Department?

INTRODUCTION Acute intervention for solid organ injury (SOI) is rare in hemodynamically stable children. Pediatric guidelines recommend admission with follow-up labs, even for low-grade injuries. METHODS Datasets from two large multi-center prospective observational studies were used to analyze a cohort of children (age <17 years) with grade I-III SOI following blunt abdominal trauma (BAT). Children with hollow viscus injuries (HVI) were excluded. Patients were divided into a) those with or without other major injuries (OMI) (traumatic brain injury, hemothorax or pneumothorax, pelvic fracture, urgent orthopedic or neurosurgical operations), and b) with Grade I/II vs. Grade III injuries. Outcomes included acute interventions (AI) (transfusion, angiography, abdominal operation) and disposition (admission unit and length of stay). RESULTS There were 14,232 children enrolled in the two studies and 791 patients had a SOI (5.6%). After excluding patients with hollow viscus injuries and higher-grade solid organ injuries, 517 patients were included with a Grade I-III SOI and 262 of these had no OMI. Among patients with no OMI, none of 148 patients with Grade I/II SOI underwent AI while only 3/114 with Grade III injuries underwent AI (3 transfusions/1 angioembolization). All 3 had hemoperitoneum; 2/3 had an additional organ with a Grade II injury. Among Grade I-II SOI with no OMI, 28/148 (18.9%) were admitted to an ICU, 110/148 (74.3%) to floor, and 7/148 (4.7%) discharged home from ED; median length of stay (LOS) 2 days. Among grade III SOI with no OMI, 38/114 (33.3%) were admitted to an ICU and 61.4% to the floor; median LOS 4 days. Among 255 patients with a Grade I-III SOI and other major organ system injuries, 31 (12.2%) underwent AI. CONCLUSIONS No patient with a Grade I-II SOI and no OMI following BAT received intervention suggesting that patients with low-grade SOI without other major injuries could be safely observed and discharged from the ED.Retrospective study LEVEL OF EVIDENCE: Level II.