PEDIATRIC TRAUMA SOCIETY CLINICAL PRACTICE GUIDELINES LIBRARY DISCLAIMER STATEMENT
"This Clinical Practice Guideline has been supplied by a hospital as an example of a clinical practice guideline to provide clinicians
at that institution with an analytical framework for the evaluation and treatment of a particular diagnosis or condition. This Clinical
Practice Guideline is not intended to establish a protocol for all patients with a particular condition, may not be replicable at other
institutions, and it is not intended to replace a clinician's clinical judgment. A clinician's adherence to this Clinical Practice Guideline
is voluntary. It is understood that some patients will not fit the clinical conditions contemplated by this Clinical Practice Guideline and
that the recommendations contained in this Clinical Practice Guideline should not be considered inclusive of all proper methods or
exclusive of other methods of care reasonably directed to obtaining the same results. Decisions to adopt any specific
recommendation of this Clinical Practice Guideline must be made by the clinician in light of available resources and the individual
circumstances presented by the patient. This guideline has not undergone expert review by the Pediatric Trauma Society and its
hosting by the Pediatric Trauma Society should not be considered an endorsement of its content or the refutation of any alternate
management strategy."
Isolated Liver and Spleen Injury Guidelines
The purpose of the following guidelines is to facilitate standardized, up-to-date, evidenced based
management of the physiologically stable pediatric trauma patient with an isolated liver or spleen
injury. Patients with additional minor injuries may also be managed according to the guidelines, if
the liver or spleen injury is their predominant injury. The plans of care as outlined below are
intended to supplement the ongoing assessment and management of a patient's treating physician.
They do not supersede clinical judgment and ought to be adjusted as necessary for the care of an
individual patient. The guidelines themselves are subject to revision in the future as our knowledge
of the optimal care of the injured child increases.
Grade I
Grade II
Grade III
Grade IV
ICU x 24hrs then
floor if stable
Admit to
floor
floor
Floor / ICU x 24hrs
(depending on
need for increased
monitoring
capability) then
floor if stable
Hospital LOS
2 days
3 days
3-4 days
4-5 days
Lab Tests
HCT 12hrs & 24hr
post injury
HCT 12hrs & 24hr
post injury
HCT 12hr, 24hr &
48hr post injury
HCT 6hrs, 12hrs &
24hrs, 48hrs post
injury
Clinical
Assessment &
monitoring
VSq 2hrs x 8hrs,
then q 4hrs;
C/R/Pox monitoring
x 24hrs; Strict I &
O
VSq 2hrs x 8hrs,
then q 4hrs;
C/R/Pox monitoring
x 24hrs; Strict I &
O
VSq 2hrs x 8hrs,
then q 4hrs;
C/R/Pox monitoring
x 24hrs; Strict I &
O
VSq 1hr x 12hrs,
then q 2hrs x 12hrs,
then q 4hrs; C/R/Pox
monitoring x 24hrs;
Strict I & O
Incentive
Spirometry q 2hrs
until ambulatory;
NG/Foley as
indicated
Incentive Spirometry
q 2hrs until
ambulatory;
NG/Foley as
indicated
Treatments &
procedures
Incentive
Spirometry prn
Incentive
Spirometry prn
Nutrition
NPO x 12hrs,
clears, then ADAT
NPO x 12hrs,
clears, then ADAT
Activity
Bedrest x 24hrs
then OOB to toilet
only. Ambulation
12hrs prior to
discharge
Bedrest x 24hrs
then OOB to toilet
only. Ambulation
12hrs prior to
discharge
NPO x 24hrs,
clears x 8hrs, then
ADAT
Bedrest x 24hrs
then OOB to toilet
only. Ambulation
12hrs prior to
discharge
IV Fluids
Maintenance IV
while NPO then
saline lock with
good PO intake
Maintenance IV
while NPO then
saline lock with
good PO intake
Maintenance IV
while NPO then
saline lock with
good PO intake
NPO x 24hrs, clears
x 8hrs, then ADAT
Bedrest x 48hrs then
OOB to toilet only.
Ambulation 12hrs
prior to discharge
Maintenance IV while
NPO then saline lock
with good PO intake
PEDIATRIC TRAUMA SOCIETY CLINICAL PRACTICE GUIDELINES LIBRARY DISCLAIMER STATEMENT
"This Clinical Practice Guideline has been supplied by a hospital as an example of a clinical practice guideline to provide clinicians
at that institution with an analytical framework for the evaluation and treatment of a particular diagnosis or condition. This Clinical
Practice Guideline is not intended to establish a protocol for all patients with a particular condition, may not be replicable at other
institutions, and it is not intended to replace a clinician's clinical judgment. A clinician's adherence to this Clinical Practice Guideline
is voluntary. It is understood that some patients will not fit the clinical conditions contemplated by this Clinical Practice Guideline and
that the recommendations contained in this Clinical Practice Guideline should not be considered inclusive of all proper methods or
exclusive of other methods of care reasonably directed to obtaining the same results. Decisions to adopt any specific
recommendation of this Clinical Practice Guideline must be made by the clinician in light of available resources and the individual
circumstances presented by the patient. This guideline has not undergone expert review by the Pediatric Trauma Society and its
hosting by the Pediatric Trauma Society should not be considered an endorsement of its content or the refutation of any alternate
management strategy."
Grade I
Grade III
Grade IV
Mild pain Tylenol
15mg/kg po/pr
q 4hrs prn
Grade II
Mild pain Tylenol 15mg/kg
po/pr q 4hrs prn
Moderate Pain Tylenol with
Codeine 1mg/kg
po q 4hrs prn
Severe Pain Morphine
0.1mg/kg IV q 24hrs prn
Mild pain - Tylenol
15mg/kg po/pr q
4hrs prn
Moderate Pain Tylenol with
Codeine 1mg/kg po
q 4hrs prn
Severe Pain Morphine 0.1mg/kg
IV q 2-4hrs prn
Mild pain - Tylenol
15mg/kg po/pr q 4hrs
prn
Moderate
Pain - Tylenol with
Codeine 1mg/kg po q
4hrs prn
Severe Pain Morphine 0.1mg/kg IV
q 2-4hrs prn
none
none
none
none
3 weeks
4 weeks
5 weeks
6 weeks
*6 weeks
*8 weeks
*12 weeks
*16 weeks
1 week
1 week
1-2 weeks
1-2 weeks
2 weeks
2 weeks
2 weeks
1-2 weeks
Medications
Pre and Post
discharge imaging
Restricted activity
for normal age
appropriate
activities
Restricted activity
for full
contact/competitive
sports or play
Return to school
Follow-up clinic visit
*Return to full-contact / competitive sports or play (Gymnastics, dance, Biking, Skiing, Snow boarding, Sled
riding, Swimming, Jungle Gyms, Skateboarding, Rollerblading, Running and Jogging, Basketball, Soccer,
Football, Boxing, Diving, Ice/Field Hockey, Lacrosse, Martial Arts, Rodeo, Rugby, Wrestling, Handball,
Mountain Climbing, etc) is at the discretion of the individual's pediatric trauma surgeon.
PEDIATRIC TRAUMA SOCIETY CLINICAL PRACTICE GUIDELINES LIBRARY DISCLAIMER STATEMENT
"This Clinical Practice Guideline has been supplied by a hospital as an example of a clinical practice guideline to provide clinicians
at that institution with an analytical framework for the evaluation and treatment of a particular diagnosis or condition. This Clinical
Practice Guideline is not intended to establish a protocol for all patients with a particular condition, may not be replicable at other
institutions, and it is not intended to replace a clinician's clinical judgment. A clinician's adherence to this Clinical Practice Guideline
is voluntary. It is understood that some patients will not fit the clinical conditions contemplated by this Clinical Practice Guideline and
that the recommendations contained in this Clinical Practice Guideline should not be considered inclusive of all proper methods or
exclusive of other methods of care reasonably directed to obtaining the same results. Decisions to adopt any specific
recommendation of this Clinical Practice Guideline must be made by the clinician in light of available resources and the individual
circumstances presented by the patient. This guideline has not undergone expert review by the Pediatric Trauma Society and its
hosting by the Pediatric Trauma Society should not be considered an endorsement of its content or the refutation of any alternate
management strategy."
PEDIATRIC TRAUMA SOCIETY CLINICAL PRACTICE GUIDELINES LIBRARY DISCLAIMER STATEMENT
"This Clinical Practice Guideline has been supplied by a hospital as an example of a clinical practice guideline to provide clinicians
at that institution with an analytical framework for the evaluation and treatment of a particular diagnosis or condition. This Clinical
Practice Guideline is not intended to establish a protocol for all patients with a particular condition, may not be replicable at other
institutions, and it is not intended to replace a clinician's clinical judgment. A clinician's adherence to this Clinical Practice Guideline
is voluntary. It is understood that some patients will not fit the clinical conditions contemplated by this Clinical Practice Guideline and
that the recommendations contained in this Clinical Practice Guideline should not be considered inclusive of all proper methods or
exclusive of other methods of care reasonably directed to obtaining the same results. Decisions to adopt any specific
recommendation of this Clinical Practice Guideline must be made by the clinician in light of available resources and the individual
circumstances presented by the patient. This guideline has not undergone expert review by the Pediatric Trauma Society and its
hosting by the Pediatric Trauma Society should not be considered an endorsement of its content or the refutation of any alternate
management strategy."