Evidence-based guidelines for resource utilization in children with isolated spleen or liver injury☆,☆☆
Section snippets
Materials and methods
Data from the case records of 856 children with isolated spleen or liver injury treated at 32 pediatric surgical centers from July 1995 to June 1997 were collected (Appendix). Twenty-six of 32 centers (81%) reported at least 15 patients. Patients with minor, remote injuries such as nondisplaced, noncomminuted fractures; soft tissue injuries; or less severe solid abdominal organ injuries were included as long as the associated injuries did not influence the variables in this study. The patients
Results
Clinical parameters in the 832 patients are described in Tables 1 and 2.Age 1-9 yr 474 (57%) 10-15 yr 308 (37%) >15 yr 50 (6%) Gender 65% boys Diagnosis by CT 99.0% (8 patients taken directly to operating room without imaging) CT grade I 116 (14%) II 341 (41%) III 275 (33%) IV 100 (12%) Mean Injury Severity Score 12.1 Empty Cell CT Grade Empty Cell I II III IV Admitted to ICU
Discussion
Evidence-based medicine involves integrating current best evidence (medical literature) with clinical expertise and patient preferences in making decisions about the care of individual patients. Evidence-based methodology is the emerging cornerstone of the clinical practice guideline process. Recently, several trauma societies have developed practice guidelines using evidence-based methodology.10
There are no randomized, controlled trials (Class I evidence) regarding optimal resource utilization
Acknowledgements
The author appreciates the many contributions of the 1997-98 APSA Trauma Committee members (Bonnie Beaver, Mary Fallat, Dennis Lund, Tres Scherer, David Meagher, Ron Sharp, Tim Canty, Robert Foglia, Enrique Grisoni, Richard Weiss, Marc Cullen) and the statistical expertise of Shirley Chuang.
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Supported in part by the APSA Foundation and the Arnold P. Gold Foundation.
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Address reprint requests to Steven Stylianos, MD, Babies & Children's Hospital of NY—Rm 207N, 3959 Broadway, New York, NY 10032.