A standard pediatric trauma laboratory panel: a plea for a minimalist approach.

ABSTRACT

BACKGROUND: Optimizing patient outcomes has promoted a protocol-driven environment within the trauma bay. No standardized laboratory panel exists during the initial evaluation of injured children. METHODS: In 2004, we implemented a standard trauma panel consisting of an i-STAT analysis (electrolytes, hematocrit, and blood gas), and type and cross. We reviewed the experience of this protocol 1 year prior (T1) and after (T2) its implementation. RESULTS: During T1, 23% of patients underwent a traditional trauma panel compared with T2 where 43.5% received the new standard trauma panel. Neither the mean number of laboratory draws per patient (T1 = 4.6 vs. T2 = 4.3, p = 0.77) nor the mean number of laboratory tests obtained (T1 = 15.0 vs. T2 = 12.7, p = 0.99) were significantly different between the two groups. The mean amount of blood drawn within the trauma bay was significantly more in T1 compared with T2 (10 mL vs. 3.8 mL, respectively, p < 0.0001). The initial laboratory costs were $307.97 during T1 and $177.51 during T2, although the mean total laboratory charges were not significantly different between the two groups (T1 = $2,119.97 vs. T2 = $2,143.77, p = 0.62). CONCLUSIONS: The implementation of a standard laboratory panel increased the uniformity of care without compromising quality. We limited the volume and initial cost of blood drawn which is advantageous in small children.