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

PICU 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 V OR
Admission Hgb ≤ 7 OR
Hemodynamically Unstable
Epic Admission Order Set
  • TraumaBluntAbdomen Grade V and/or PICU
  • Strict Bedrest x 24 hours from injury
  • THEN
  • Bedrest w/ bathroom privileges x 24 hours
  • THEN
  • Advance activity as tolerated
  • NPO x 24 hours
  • Advance based on clinical status
Lab Tests
  • CBC q 8 hours until stable trend
  • AND
  • 36 hours from injury
  • AND
  • Consider 4 - 6 hours post-ambulation
  • UA, LFTs, Amylase, Lipase
    • Repeat if previously abnormal
Vital Signs
  • Every 1 hour while in PICU
  • Then every 4 hours until discharge
  • Continuous CR Monitor and Pulse Oximetry x 24 - 48 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