Adherence to APSA activity restriction guidelines and 60-day clinical outcomes for pediatric blunt liver and splenic injuries (BLSI)

David M. Notrica, Lois W. Sayrs, Nidhi Krishna, Daniel J. Ostlie, Robert W. Letton, Adam C. Alder, Shawn D. St. Peter, Todd A. Ponsky, James Eubanks, David W. Tuggle, Nilda M. Garcia, Charles M. Leys, R. Todd Maxson, Amina M. Bhatia

Research output: Contribution to journalArticle

Abstract

Background: After NOM for BLSI, APSA guidelines recommend activity restriction for grade of injury + 2 in weeks. This study evaluates activity restriction adherence and 60 day outcomes. Methods: Non-parametric tests and logistic regression were utilized to assess difference between adherent and non-adherent patients from a 3-year prospective study of NOM for BLSI (≤ 18 years). Results: Of 1007 children with BLSI, 366 patients (44.1%) met the inclusion criteria of a completed 60 day follow-up; 170 (46.4%) had liver injury, 159 (43.4%) had spleen injury and 37 (10.1%) had both. Adherence to recommended activity restriction was claimed by 279 (76.3%) patients; 49 (13.4%) reported non-adherence and 38 (10.4%) patients had unknown adherence. For 279 patients who adhered to activity restrictions, unplanned return to the emergency department (ED) was noted for 35 (12.5%) with 16 (5.7%) readmitted; 202 (72.4%) returned to normal activity by 60 days. No patient bled after discharge. There was no statistical difference between adherent patients (n = 279) and non-adherent (n = 49) for return to ED (χ2 = 0.8 [p < 0.4]) or readmission (χ2 = 3.0 [p < 0.09]); for 216 high injury grade patients, there was no difference between adherent (n = 164) and non-adherent (n = 30) patients for return to ED (χ2 = 0.6 [p < 0.4]) or readmission (χ2 = 1.7 [p < 0.2]). Conclusion: For children with BLSI, there was no difference in frequencies of bleeding or ED re-evaluation between patients adherent or non-adherent to the APSA activity restriction guideline. Level of evidence: Level II, Prognosis.

LanguageEnglish (US)
JournalJournal of Pediatric Surgery
DOIs
StateAccepted/In press - Jan 1 2018
Externally publishedYes

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Guidelines
Pediatrics
Liver
Wounds and Injuries
Hospital Emergency Service
Spleen
Logistic Models
Prospective Studies
Hemorrhage

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pediatrics, Perinatology, and Child Health

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Adherence to APSA activity restriction guidelines and 60-day clinical outcomes for pediatric blunt liver and splenic injuries (BLSI). / Notrica, David M.; Sayrs, Lois W.; Krishna, Nidhi; Ostlie, Daniel J.; Letton, Robert W.; Alder, Adam C.; St. Peter, Shawn D.; Ponsky, Todd A.; Eubanks, James; Tuggle, David W.; Garcia, Nilda M.; Leys, Charles M.; Maxson, R. Todd; Bhatia, Amina M.

In: Journal of Pediatric Surgery, 01.01.2018.

Research output: Contribution to journalArticle

Notrica, DM, Sayrs, LW, Krishna, N, Ostlie, DJ, Letton, RW, Alder, AC, St. Peter, SD, Ponsky, TA, Eubanks, J, Tuggle, DW, Garcia, NM, Leys, CM, Maxson, RT & Bhatia, AM 2018, 'Adherence to APSA activity restriction guidelines and 60-day clinical outcomes for pediatric blunt liver and splenic injuries (BLSI)' Journal of Pediatric Surgery. https://doi.org/10.1016/j.jpedsurg.2018.08.061
Notrica, David M. ; Sayrs, Lois W. ; Krishna, Nidhi ; Ostlie, Daniel J. ; Letton, Robert W. ; Alder, Adam C. ; St. Peter, Shawn D. ; Ponsky, Todd A. ; Eubanks, James ; Tuggle, David W. ; Garcia, Nilda M. ; Leys, Charles M. ; Maxson, R. Todd ; Bhatia, Amina M. / Adherence to APSA activity restriction guidelines and 60-day clinical outcomes for pediatric blunt liver and splenic injuries (BLSI). In: Journal of Pediatric Surgery. 2018.
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abstract = "Background: After NOM for BLSI, APSA guidelines recommend activity restriction for grade of injury + 2 in weeks. This study evaluates activity restriction adherence and 60 day outcomes. Methods: Non-parametric tests and logistic regression were utilized to assess difference between adherent and non-adherent patients from a 3-year prospective study of NOM for BLSI (≤ 18 years). Results: Of 1007 children with BLSI, 366 patients (44.1{\%}) met the inclusion criteria of a completed 60 day follow-up; 170 (46.4{\%}) had liver injury, 159 (43.4{\%}) had spleen injury and 37 (10.1{\%}) had both. Adherence to recommended activity restriction was claimed by 279 (76.3{\%}) patients; 49 (13.4{\%}) reported non-adherence and 38 (10.4{\%}) patients had unknown adherence. For 279 patients who adhered to activity restrictions, unplanned return to the emergency department (ED) was noted for 35 (12.5{\%}) with 16 (5.7{\%}) readmitted; 202 (72.4{\%}) returned to normal activity by 60 days. No patient bled after discharge. There was no statistical difference between adherent patients (n = 279) and non-adherent (n = 49) for return to ED (χ2 = 0.8 [p < 0.4]) or readmission (χ2 = 3.0 [p < 0.09]); for 216 high injury grade patients, there was no difference between adherent (n = 164) and non-adherent (n = 30) patients for return to ED (χ2 = 0.6 [p < 0.4]) or readmission (χ2 = 1.7 [p < 0.2]). Conclusion: For children with BLSI, there was no difference in frequencies of bleeding or ED re-evaluation between patients adherent or non-adherent to the APSA activity restriction guideline. Level of evidence: Level II, Prognosis.",
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T1 - Adherence to APSA activity restriction guidelines and 60-day clinical outcomes for pediatric blunt liver and splenic injuries (BLSI)

AU - Notrica, David M.

AU - Sayrs, Lois W.

AU - Krishna, Nidhi

AU - Ostlie, Daniel J.

AU - Letton, Robert W.

AU - Alder, Adam C.

AU - St. Peter, Shawn D.

AU - Ponsky, Todd A.

AU - Eubanks, James

AU - Tuggle, David W.

AU - Garcia, Nilda M.

AU - Leys, Charles M.

AU - Maxson, R. Todd

AU - Bhatia, Amina M.

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N2 - Background: After NOM for BLSI, APSA guidelines recommend activity restriction for grade of injury + 2 in weeks. This study evaluates activity restriction adherence and 60 day outcomes. Methods: Non-parametric tests and logistic regression were utilized to assess difference between adherent and non-adherent patients from a 3-year prospective study of NOM for BLSI (≤ 18 years). Results: Of 1007 children with BLSI, 366 patients (44.1%) met the inclusion criteria of a completed 60 day follow-up; 170 (46.4%) had liver injury, 159 (43.4%) had spleen injury and 37 (10.1%) had both. Adherence to recommended activity restriction was claimed by 279 (76.3%) patients; 49 (13.4%) reported non-adherence and 38 (10.4%) patients had unknown adherence. For 279 patients who adhered to activity restrictions, unplanned return to the emergency department (ED) was noted for 35 (12.5%) with 16 (5.7%) readmitted; 202 (72.4%) returned to normal activity by 60 days. No patient bled after discharge. There was no statistical difference between adherent patients (n = 279) and non-adherent (n = 49) for return to ED (χ2 = 0.8 [p < 0.4]) or readmission (χ2 = 3.0 [p < 0.09]); for 216 high injury grade patients, there was no difference between adherent (n = 164) and non-adherent (n = 30) patients for return to ED (χ2 = 0.6 [p < 0.4]) or readmission (χ2 = 1.7 [p < 0.2]). Conclusion: For children with BLSI, there was no difference in frequencies of bleeding or ED re-evaluation between patients adherent or non-adherent to the APSA activity restriction guideline. Level of evidence: Level II, Prognosis.

AB - Background: After NOM for BLSI, APSA guidelines recommend activity restriction for grade of injury + 2 in weeks. This study evaluates activity restriction adherence and 60 day outcomes. Methods: Non-parametric tests and logistic regression were utilized to assess difference between adherent and non-adherent patients from a 3-year prospective study of NOM for BLSI (≤ 18 years). Results: Of 1007 children with BLSI, 366 patients (44.1%) met the inclusion criteria of a completed 60 day follow-up; 170 (46.4%) had liver injury, 159 (43.4%) had spleen injury and 37 (10.1%) had both. Adherence to recommended activity restriction was claimed by 279 (76.3%) patients; 49 (13.4%) reported non-adherence and 38 (10.4%) patients had unknown adherence. For 279 patients who adhered to activity restrictions, unplanned return to the emergency department (ED) was noted for 35 (12.5%) with 16 (5.7%) readmitted; 202 (72.4%) returned to normal activity by 60 days. No patient bled after discharge. There was no statistical difference between adherent patients (n = 279) and non-adherent (n = 49) for return to ED (χ2 = 0.8 [p < 0.4]) or readmission (χ2 = 3.0 [p < 0.09]); for 216 high injury grade patients, there was no difference between adherent (n = 164) and non-adherent (n = 30) patients for return to ED (χ2 = 0.6 [p < 0.4]) or readmission (χ2 = 1.7 [p < 0.2]). Conclusion: For children with BLSI, there was no difference in frequencies of bleeding or ED re-evaluation between patients adherent or non-adherent to the APSA activity restriction guideline. Level of evidence: Level II, Prognosis.

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