The Center For Prospective Clinical Trials The Children's Mercy Hospital Kansas City, MO.
J Pediatr Surg. 2013 Dec;48(12):2437-41. doi: 10.1016/j.jpedsurg.2013.08.018.
Current APSA recommendations for blunt spleen/liver injury (BSLI) entail bedrest equal to grade of injury plus one. We reported our experience 3 years ago with a prospectively implemented abbreviated protocol, one concern of which was that more numbers would be needed to support the safety of such a protocol. We are now reporting the final experience with this protocol as we move forward with further investigation.
Following IRB approval, data were collected prospectively in all patients with BSLI up to 8 weeks after discharge. There were no exclusion criteria, and patient accrual was consecutive. Bedrest was restricted to one night for Grade I & II injuries and two nights for Grade ≥ III.
Between 11/2006 and 10/2012, 249 patients were admitted with BSLI. Mean age and weight were 10.3±4.8 years and 40.1±19.8 kg, respectively. Injuries included isolated spleen in 130 (52%), liver only in 107 (43%), and both in 12 (5%). One splenectomy was required for a grade V injury. Transfusions were used in 40 patients (16%), with 28 (11%) due to the injured solid organ. Bedrest for solid organ injury was applicable to 199 patients (80%), for which the mean grade of injury was 2.7±1.0 and mean bedrest was 1.6±0.6 days, resulting in 2.5±1.9 days of hospitalization. The need for bedrest was the limiting factor for length of stay in 155 patients (62%), for which mean grade of injury was 2.5±1.0 and mean bedrest was 1.6±0.6 days, resulting in 1.7±0.8 days of hospitalization. There were 4 deaths, 3 from brain injury and 1 from grade V liver injury. There were no patients readmitted for complications of solid organ injury.
These data further validate that an abbreviated protocol of one night of bedrest for grade I and II injuries and two nights for grade ≥ III can be safely employed, resulting in dramatic decreases in hospitalization compared to the current APSA recommendations.
目前，APSA 对钝性脾/肝损伤（BSLI）的建议是，根据损伤等级加一的原则卧床休息。我们在 3 年前报告了前瞻性实施简化方案的经验，其中一个担忧是，需要更多的病例来支持该方案的安全性。随着进一步的研究，我们现在报告该方案的最终经验。
在获得机构审查委员会批准后，前瞻性收集所有 BSLI 患者出院后 8 周内的数据。没有排除标准，患者入组是连续的。对于 I 级和 II 级损伤，卧床休息限制在 1 晚；对于≥III 级损伤，卧床休息限制在 2 晚。
在 2006 年 11 月至 2012 年 10 月期间，共有 249 例 BSLI 患者入院。平均年龄和体重分别为 10.3±4.8 岁和 40.1±19.8kg。损伤包括单纯脾损伤 130 例（52%），单纯肝损伤 107 例（43%），脾肝同时损伤 12 例（5%）。1 例 V 级损伤需要行脾切除术。40 例（16%）患者需要输血，其中 28 例（11%）是由于实质脏器损伤所致。199 例（80%）实质脏器损伤患者适用卧床休息，其平均损伤等级为 2.7±1.0，平均卧床休息时间为 1.6±0.6 天，导致住院时间为 2.5±1.9 天。在 155 例（62%）需要卧床休息的患者中，卧床休息是住院时间延长的限制因素，其平均损伤等级为 2.5±1.0，平均卧床休息时间为 1.6±0.6 天，导致住院时间为 1.7±0.8 天。有 4 例死亡，3 例死于脑损伤，1 例死于 V 级肝损伤。没有患者因实质脏器损伤并发症而再次入院。
这些数据进一步证实，对于 I 级和 II 级损伤，1 晚卧床休息，对于≥III 级损伤，2 晚卧床休息的简化方案是安全的，可以显著减少与目前 APSA 建议相比的住院时间。
