Outcomes of an accelerated care pathway for pediatric blunt solid organ injuries in a public healthcare system
| Autor: | Carlos R. Alvarez-Allende, Bryce Weber, Steven R. Lopushinsky, Oluwatomilayo Daodu, Lisette Lockyer, Mary Brindle |
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| Rok vydání: | 2017 |
| Předmět: |
Male
medicine.medical_specialty Adolescent National Health Programs Cost effectiveness Cost-Benefit Analysis Abdominal Injuries Wounds Nonpenetrating Alberta 03 medical and health sciences Injury Severity Score 0302 clinical medicine Blunt Trauma Centers medicine Humans Hospital Costs Child Retrospective Studies Liver injury business.industry Infant Newborn Infant 030208 emergency & critical care medicine Retrospective cohort study General Medicine Emergency department Length of Stay medicine.disease Surgery Treatment Outcome Child Preschool 030220 oncology & carcinogenesis Multivariate Analysis Pediatrics Perinatology and Child Health Emergency medicine Critical Pathways Female Patient Safety business Blood drawing Pediatric trauma |
| Zdroj: | Journal of Pediatric Surgery. 52:826-831 |
| ISSN: | 0022-3468 |
| DOI: | 10.1016/j.jpedsurg.2017.01.037 |
| Popis: | An accelerated clinical care pathway for solid organ abdominal injuries was implemented at a level one pediatric trauma center. The impact on resource utilization and demonstration of protocol safety was assessed.Data were collected retrospectively on patients admitted with blunt abdominal solid organ injuries from 2012 to 2015. Patients were subdivided into pre- and post-protocol groups. Length of hospital stay (LOS) and failure of non-operative treatment were the primary outcomes of interest.138 patients with solid organ injury were studied: 73 pre- (2012-2014) and 65 post-protocol (2014-2015). There were no significant differences in age, gender, injury severity score (ISS), injury grade, or mechanism (p0.05). LOS was shorter post-protocol (mean 5.6 vs. 3.4days; median 5 .0 vs. 3.0days; p=0.0002), resulting in average savings of $5966 per patient. Patients in the protocol group mobilized faster (p0.0001) and experienced fewer blood draws (p=0.02). On multivariate analysis, protocol group (p0.001) and ISS (p0.001) were independently associated with LOS. There were no differences between groups in the need for operation, embolization, or transfusion.An accelerated care pathway is safe and effective in the management of pediatric solid organ injuries with early mobilization, less blood draws, and decreased LOS without significant morbidity and mortality.Therapeutic, cost effectiveness, level III. |
| Databáze: | OpenAIRE |
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