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Solid organ injury clinical pathway

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Clinical pathway

Injury pathway

Clinical management

  Grade I Grade II Grade III Grade IV & above
Anticipated LOS <2 days <2 days 2-3 days 3-4 days
Admit to Surgical ward PICU if haemodynamically unstable, otherwise surgical ward
Activity Bed rest overnight, toilet privileges after 12 hours. Full, gentle ambulation at 24 hours Bed rest overnight, toilet privileges after 24 hours. Full, gentle ambulation at 48hours
Aim for full ambulation at least 12 hours prior to discharge
Vital signs 4 hourly until discharge (As per PEWS) Hourly if in PICU then 4 hourly as per PEWS
Monitoring Temperature, pulse respirations, blood pressure.   Strict fluid balance, serial abdominal examinations
Lab tests

FBC
Other lab tests
Frequency (Grade I - III) 

Repeat Hb 6 - 12 hours post admission
Repeat if initially abnormal as clinically indicated
  Frequency (Grade IV or above)

6,12 and 24 hours post admission
IV Fluids See Starship IV Fluids guideline.
Treat any haemodynamic instability as per ATOMAC guidelines. Call consultant if any haemodynamic instability
  PICU IV Fluids guideline if admitted to PICU otherwise  Starship IV Fluids guideline
Nutrition Clear fluids progressing to full diet as tolerated   NBM overnight, progressing to clear fluids and full diet as tolerated
Pain  (See Starship pain guideline) Consider referral to Starship Pain service
Consult renal analgesia guideline if known renal impairment  
Procedures and treatments  No urinary catheter (IDC)
No nasogastric tube
Deep breathing exercises, bubbles, mobilise early (as above)
IDC if haemodynamically unstable. Physiotherapy review for deep breathing exercises.

Discharge recommendations

  Grade I Grade II Grade III Grade IV & above
Restricted activity from full
contact / competitive sports or play
3 weeks 4 weeks 6 weeks (from time of accident)
Return to school 1 week 1 week 1 week 2 weeks
Follow up GP in 1 week GP in 1 week GP in 1 week
& Paediatric Surgery
in 6 weeks
GP in 1 week
& Paediatric Surgery
in 6 weeks

No full contact/physical activities or competitive sports includes:

Activities/sports where there is contact or the potential for contact. For example:

  • Gymnastics or Dancing
  • Cycling, Scooter riding, Quad-biking, Horse riding, Skateboarding or Rollerblading
  • Skiing, Snowboarding or Sledding, 
  • Climbing, Jungle Gyms, Playgrounds, Running or Jogging,
  • Basketball, Soccer, Rugby, Aussie Rules, Hockey
  • Diving or playing in the Surf 
  • Boxing, Martial Arts, Wrestling, Weight Lifting, or any Rough Play

Avoid any activities that could lead to a hit to the abdomen.

Activities allowed at discharge are any NON-CONTACT physical activities: 

Walking is fine, and can swim in private pool doing laps or to cool off in summer. No public pools or ocean swimming, no diving, or playing with friends/siblings in pool. Activities your child can do include reading, colouring, board games, arts and crafts activities, video games, TV, etc.

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Document Control

  • Date last published: 28 February 2019
  • Document type: Clinical Guideline
  • Services responsible: Children’s Emergency Department
  • Author(s): James Hamill, Matt Sawyer
  • Owner: Matt Sawyer
  • Editor: Greg Williams
  • Review frequency: 2 years

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