Rationale and Comments

Preset timed interval measurements of hemoglobin and hematocrit are no longer indicated as early detectors of instability. Clinical instability is defined by physiologic criteria such as age-specific tachycardia or hypotension, tachypnea, low urine output, altered mental status, or any significant clinical deterioration that warrants increased level of care and investigation. Therefore, the routine use of repeat laboratory studies in children with isolated solid organ injury who have physiologically normal vital signs for their age is not necessary.

Sponsoring Organizations

• American Academy of Nursing

Sources

• Expert consensus

Disciplines

• Emergency medicine
• Hematologic
• Pediatric

References

• Acker S, Petrun B, Partrick D, Roosevelt, G, Bensard D. Lack of utility of repeat monitoring of hemoglobin and hematocrit following blunt solid organ injury in children. J Trauma Acute Care Surg. 2015;79:991-994.
  
• Fallon S, Delemos D, Akinkuotu A, Christopher D, Naik-Mathuria B. The use of an institutional pediatric abdominal trauma protocol improves resource use. J Trauma Acute Care Surg. 2016; 80:57-63.
  
• Golden J, Mitchell I, Kuzniewski S, Lipskar A, Prince J, Bank A, Stylianos S, Rosen G. Reducing scheduled phlebotomy in stable pediatric patients with blunt liver or spleen injury. J Pediatr Surg. 2014;49:759-762.
  
• Holmes JF, Lillis K, Monroe D, Borgialli D, Kerrey B,Mahajn P, Adegais K, Ellison A, Yen K, Atabaki S, Menaker J, Bonsu B, Quayle KS, Garcia M, Rogers A, Blumber S, Lee L, Tunik M, Kooistra J, Kowk M, Cook L, Dean JM, Sokolove PE, Wisne DH, Ehrlich P, Cooper A, Dayan PS, Wootton-Geroges S, Kuppermann N, Pediatric Emergency Care Applied Research Network (PECARN). Identifying children at very low risk of clinically important blunt abdominal injuries. Ann Emerg Med. 2013;62(2):107-116.