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

Inpatient Unit Admission Guidelines

Any change in hemodynamic status prompts deviation from pathway with patient treated as clinically warranted
Failure of nonoperative management is uncommon (< 5 %) and is significantly associated with injury severity, pancreatic injury, and multiple organ system involvement
The need for operative intervention is typically determined within 12 hours of the injury

Grade I-II
Grades III-IV
Epic Admission Order Set
  • TraumaBluntAbdomen Grade I-II FLOOR
  • TraumaBluntAbdomen Grade III-IV FLOOR
  • Ad Lib
  • Bedrest w/ bathroom privileges x 24 hours from injury
  • THEN
  • Advance activity as tolerated
  • Regular diet
Lab Tests
  • CBC
  • Every 8 hours until stable trend
  • AND
  • Consider 4 - 6 hours post-ambulation
  • UA, LFTs, Amylase, Lipase
  • Repeat if previously abnormal
Vital Signs
  • Every 4 hours
  • As needed
  • Continuous CR Monitor and Pulse Oximetry x 24 hours (Minimum)
Treatment and Procedures
  • Incentive Spirometry
  • SCD (if age appropriate)
Pain Management
  • Mild: Acetaminophen (PO, PR)
  • Moderate: Oxycodone (PO)
  • Severe: Morphine (IV)
  • Grade 3 and above renal injuries require a formal Urology consult
  • Other consults as clinically indicated