Canadian Association of General Surgeons evidence based reviews in surgery. 11. Evidence-based guidelines for children with isolated spleen or liver injury.

Objective: To determine the impact of clinical practice guidelines (CPGs) on the management of trauma to the pediatric spleen and liver. Data sources: The CPGs were formulated by the American Pediatric Surgery Association (APSA) based on evidence from multiple sources including published non-randomized trials, historical controls and expert clinical experience and consensus, along with a retrospective review of 856 children with isolated spleen or liver injuries treated at 32 centres of pediatric surgery from June 1995 to July 1997. CPG implementation: The CPGs were applied prospectively in 312 children treated nonoperatively at 16 centres between 1998 and 2000. Compliance was analyzed for age, gender, the organ injured and its grade by computed tomography. All patients underwent follow-up for 4 months. Outcomes: Hospital stay, follow-up imaging and interval of activity restriction. Main results: Compared with the 832 patients previously studied, the 312 patients who had prospective application of the proposed guidelines had significant reductions in intensive-care-unit (ICU) and hospital stay (both p < 0.0006), follow-up imaging (p < 0.0001) and interval of rest from physical activity (p < 0.05) at each grade of injury. Conclusion: Application of specific CPGs based on injury severity has resulted in conformity in patient management, improved utilization of resources and validation of guideline safety.