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Invited Critique
October 20, 2008

Safety of Early Mobilization of Patients With Blunt Solid Organ Injuries—Invited Critique

Arch Surg. 2008;143(10):977. doi:10.1001/archsurg.143.10.977

This article makes the point that long periods of immobilization are not an essential part of the NOM of blunt solid organ injuries. Based on the substantial experience of the trauma group at the University of California, Davis, the authors question the wisdom of forcing otherwise stable patients to remain at bed rest. Their bias is based on the results of this retrospective review of patients with blunt injury to the spleen (n = 182), liver (n = 196), and kidney (n = 76) that did not require early operative intervention and who did not have associated orthopedic or neurologic injures that precluded mobilization. Because they could find no association between day of ambulation and failure of NOM, they conclude that the protocols incorporating a period of strict bed rest are unjustified and may contribute to morbidity, longer hospital lengths of stay, and higher hospital costs. Although I largely agree with the observation that day of mobilization has little to do with the incidence or risk of failure of NOM, I disagree with abandoning protocols or care plan guidelines for NOM of solid organ injuries. Indeed, the authors reference studies that demonstrate decreased lengths of stay related to the use of just such protocols.

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