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Implementation of an evidence-based accelerated pathway: can hospital length of stay for children with blunt solid organ injury be safely decreased?

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Abstract

Background

Recent work has demonstrated that an accelerated pathway for pediatric patients with blunt solid organ injuries is safe; however, this is not well-studied in a dual trauma center. We hypothesized that implementation of an accelerated pathway would decrease length of stay (LOS) and hospitalization cost without increased mortality.

Methods

Retrospective review of patients < 15 years presenting to a dual level 1 trauma center between 2015 and 2020 with traumatic blunt liver and splenic injuries. Patients presenting pre- and post-protocol implementation were compared. The primary outcome was total hospital LOS. Secondary outcomes were number of lab draws, intensive care unit (ICU) LOS, cost of hospitalization, readmissions within 30 days, and mortality.

Results

103 patients were evaluated, 67 pre-protocol and 63 post-protocol. LOS was significantly shorter post-protocol (2 days vs. 4 days, p < 0.001). The ICU LOS was unchanged. There was a decrease in direct hospitalization cost per patient from $6,246 pre-protocol to $4,294 post-protocol (p = 0.001). There was one readmission post-protocol and none pre-protocol. There were no deaths.

Conclusion

Implementation of an accelerated pathway for management of blunt solid organ injury at a dual trauma center was associated with decreased LOS and decreased costs with no increased morbidity or mortality.

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Funding

The project described was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through grant number UL1 TR001860 for author EB. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

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Authors and Affiliations

  1. Department of Surgery, University of California-Davis, Sacramento, CA, USA

    Sarah C. Stokes, Erin G. Brown, Jordan E. Jackson, David E. Leshikar & Jacob T. Stephenson

  2. Department of Surgery, University of California, Davis, 2335 Stockton Blvd, Room 5107, Sacramento, CA, 95817, USA

    Sarah C. Stokes

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  1. Sarah C. Stokes
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  2. Erin G. Brown
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  3. Jordan E. Jackson
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  4. David E. Leshikar
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Sarah Stokes. The first draft of the manuscript was written by Sarah Stokes and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Sarah C. Stokes.

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Stokes, S.C., Brown, E.G., Jackson, J.E. et al. Implementation of an evidence-based accelerated pathway: can hospital length of stay for children with blunt solid organ injury be safely decreased?. Pediatr Surg Int 37, 695–704 (2021). https://doi.org/10.1007/s00383-021-04896-0

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  • DOI: https://doi.org/10.1007/s00383-021-04896-0

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