Guidelines for blunt liver and spleen injury (BLSI) by the Arizona-Texas-Oklahoma-Memphis-Arkansas Consortium (ATOMAC) emphasize hemodynamic stability over injury grade when considering non-operative management (NOM). In this study, we examined rates of intensive care unit (ICU) admission for children with isolated low-risk BLSI among US hospitals. The National Trauma Data Bank (NTDB) was queried for patients ages 1-15 admitted between 2017 and 2019 with BLSI. Patients with penetrating injuries and/or concomitant non-abdominal injuries with AIS score ≥3 were excluded. Isolated BLSI was considered low-risk if the patient had normal admission vitals and did not require operative intervention. Primary outcomes measured were ICU admission, ICU length of stay (LOS), and overall LOS. 5777 patients ages 15 and under presented with isolated BLSI during the study period. 2031/5777 (35.2%) were considered low-risk. Low-risk patients had lower rates of ICU admission compared to high-risk patients (30.9% vs. 41.6%, p < 0.001) and had shorter ICU LOS (median 2 days vs. 2, p < 0.001) and shorter overall LOS (median 41 h vs. 54, p < 0.001). Pediatric verified and non-pediatric verified trauma centers had similar rates of ICU admission (36.8% vs. 38.9%, p = 0.11). Further work is needed to capture opportunities for reduction in ICU utilization in isolated BLSI. III

中文翻译：

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减少儿科肝脏和脾脏钝性损伤重症监护病房资源利用率的机会：国家创伤数据库分析

亚利桑那-德克萨斯-俄克拉荷马-孟菲斯-阿肯色联盟 (ATOMAC) 的钝性肝脾损伤 (BLSI) 指南在考虑非手术治疗 (NOM) 时强调血流动力学稳定性而非损伤级别。在这项研究中，我们调查了美国医院中患有孤立性低风险 BLSI 儿童的重症监护病房 (ICU) 入住率。国家创伤数据库 (NTDB) 查询了 2017 年至 2019 年间因 BLSI 入院的 1-15 岁患者。排除 AIS 评分≥3 的穿透伤和/或伴随非腹部损伤的患者。如果患者入院时生命体征正常且不需要手术干预，则孤立性 BLSI 被认为是低风险。测量的主要结果是 ICU 入院、ICU 住院时间 (LOS) 和总体 LOS。研究期间，5777 名 15 岁及以下的患者出现孤立性 BLSI。 2031/5777 (35.2%) 被认为是低风险。与高风险患者相比，低风险患者入住 ICU 的比例较低（30.9% vs. 41.6%，p < 0.001），并且 ICU LOS 较短（中位 2 天 vs. 2 天，p < 0.001），总体 LOS 较短（中位数 41 小时与 54 小时，p < 0.001）。经儿科验证和未经儿科验证的创伤中心的 ICU 入住率相似（36.8% vs. 38.9%，p = 0.11）。需要进一步开展工作来抓住减少隔离 BLSI 中 ICU 使用率的机会。三、