Pediatric blunt liver and spleen injury treated in hospitals with pediatric intensive care units: Post-hoc analysis of a multicenter, retrospective observational study

Background: We evaluated the outcomes of pediatric patients with blunt liver and spleen injury (BLSI) admitted to hospitals with pediatric intensive care units (PICUs). Methods: A post-hoc analysis of a multicenter observational study on pediatric patients (≤16 years) with BLSI at 83 hospitals between 2008 and 2019 was conducted. Thirty-day mortality and BLSI-associated adverse events were compared between patients treated in hospitals with and without PICUs. Estimated 30-day mortality was compared, adjusting for demographics, comorbidities, injury mechanism and severity, and resuscitative treatments using inverse probability weighting. Results: Among 1401 patients, 421 were treated in hospitals with PICUs and 207 were admitted to a PICU. The 30-day mortality was 3 (0.7 %) and 13 (1.3 %) in patients treated in hospitals with and without PICUs, respectively, and was comparable between the patients treated in PICUs and adult ICUs (1 [0.5 %] vs. 9 [1.9 %]). The adjusted 30-day mortality was lower in patients treated in hospitals with PICUs than in those treated in hospitals with adult ICUs (3 [0.2 %] vs. 13 [1.0 %]; odds ratio 0.22 [0.06–0.79]; p = 0.012) and in those treated in PICUs than in those treated in adult ICUs (2 [0.3 %] vs. 10 [1.5 %]; odds ratio 0.22 [0.05–0.98]; p = 0.041). BLSI-related adverse events were similar regardless of the PICU availability or admission, except for emergency hemostasis of ruptured pseudoaneurysm, which was fewer in patients treated in hospitals with PICUs. Conclusions: Adverse events, including 30-day mortality, were rare, regardless of PICU availability, and the adjusted 30-day mortality was lower in patients treated in PICUs.