• Leah Plumblee, Regan Williams, Dennis Vane, Jingwen Zhang, Aaron Jensen, Bindi Naik-Mathuria, Lauren Evans, and Christian J Streck.
• From the Department of Surgery (L.P., D.V., J.Z., C.J.S.), Division of Pediatric Surgery, Medical University of South Carolina, Charleston, South Carolina; Division of Pediatric Surgery (R.W.), Le Bonheur Children's Hospital, Children's Foundation Research Institute, University of Tennessee Health Science Center, Memphis, Tennessee; Division of Pediatric Surgery (A.J.), University of California San Francisco Benioff Children's Hospital Oakland, Oakland, California; and Division of Pediatric Surgery, Department of Surgery (B.N.-M., L.E.), Baylor College of Medicine, Houston, Texas.
• J Trauma Acute Care Surg. 2020 Nov 1; 89 (5): 887-893.

IntroductionAcute intervention (AI) for solid organ injury (SOI) is rare in hemodynamically stable children. Pediatric guidelines recommend admission with follow-up laboratories, even for low-grade injuries.MethodsData sets from two large multicenter prospective observational studies were used to analyze a cohort of children (age, <17 years) with grade I to III SOI following blunt abdominal trauma. Children with hollow viscus injuries were excluded. Patients were divided into (a) those with or without other major injuries (OMIs) (traumatic brain injury, hemothorax or pneumothorax, pelvic fracture, urgent orthopedic or neurosurgical operations) and (b) with grade I or II versus grade III injuries. Outcomes included AIs (transfusion, angiography, abdominal operation) and disposition (admission unit and length of stay).ResultsThere 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 SOIs, 517 patients with a grade I to III SOI were included, and 262 of these had no OMI. Among patients with no OMI, none of 148 patients with grade I or II SOI underwent AI, while only 3 of 114 patients with grade III injuries underwent AI (3 transfusions/1 angioembolization). All three had hemoperitoneum; two of three had an additional organ with a grade II injury. Among grade I and II SOIs with no OMI, 28 (18.9%) of 148 were admitted to an intensive care unit, 110 (74.3%) of 148 to floor, and 7 (4.7%) of 148 discharged home from emergency department; median length of stay 2 days. Among grade III SOIs with no OMI, 38 (33.3%) of 114 were admitted to an intensive care unit and 61.4% to the floor; median length of stay was 4 days. Among 255 patients with a grade I to III SOI and other major organ system injuries, 31 (12.2%) underwent AI.ConclusionNo patient with a grade I and II SOI and no OMI following blunt abdominal trauma received intervention, suggesting that patients with low-grade SOI without OMIs could be safely observed and discharged from the emergency department.Level Of EvidenceTherapeutic study, level IV.

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