Emergency Department, Inpatient, and ICU Clinical Pathway for Children with Blunt Abdominal Solid Organ Injury

Clinical Pathways Home Emergency ICU Inpatient Outpatient Specialty Care Primary Care

Goals and Metrics

Solid Organ Injury Suspected

Review
History and Physical
ED/Trauma Labs
CT with IV Contrast
Delayed Images for Renal Injuries

Liver, Spleen, or Kidney Injury confirmed by CT
Determine Grade
Consult Urology for > 3 grade kidney injuries including any disruption of the collecting system
If multiple solid organ injuries use highest grade

Hemodynamically stable AND
Injury Grade ≤ IV AND
Admission Hgb ≥ 7

Hemodynamically stable AND
Injury Grade V OR
Admission Hgb ≤ 7

Hemodynamically unstable

Improvement with isotonic
fluid administration and/or
PRBC transfusion

Yes

Consider surgical intervention

Admit to Inpatient Unit

Admit to PICU

Change in hemodynamics

Transfer to floor from PICU IF:
Hemodynamically stable AND
Hgb stable without transfusion in last 24 hrs

Discharge Planning

Posted: February 2014
Revised: March 2017, March 2019 (Reviewed), June 2021, September 2021
Authors: D. Perks, CRNP, MSN; M. Nance, MD; J. Osipowicz, CRNP

Evidence

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.