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
Activity	Strict Bedrest x 24 hours from injury THEN Bedrest w/ bathroom privileges x 24 hours THEN Advance activity as tolerated
Nutrition	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
Monitoring	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) No NSAIDS
Consults	Grade 3 and above renal injuries require a formal Urology consult Other consults as clinically indicated

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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.