Hospital characteristics associated with the management of pediatric splenic injuries.
BACKGROUND
Despite evidence that more than 90% of children with traumatic injuries to the spleen can be successfully managed nonoperatively, there is significant variation in the use of splenectomy. As asplenic children are at increased risk of overwhelming postsplenectomy infection, nonoperative management may be considered a quality of care indicator.


OBJECTIVE
To test the hypothesis that children are more likely to undergo splenectomy in general hospitals than in children's hospitals.


METHODS
Retrospective cohort study using data from the Kid's Inpatient Database (KID) for the year 2000. Multivariable regression was used to control for patient and hospital characteristics.


METHODS
All children aged 0 to 16 years who were hospitalized with a traumatic (noniatrogenic) spleen injury in nonfederal short-stay hospitals in any of the 27 states participating in KID (N = 2851).


METHODS
Splenectomy performed within 1 day of arrival.


RESULTS
A total of 11 children (3%) with splenic injuries receiving care at children's hospitals underwent splenectomy compared with 383 children (15.4%) cared for at general hospitals (P<.001). After adjusting for patient characteristics, injury severity, and hospital characteristics, splenectomy was more likely among children treated at general hospitals (odds ratio, 5.01; 95% confidence interval, 2.21-11.36) than among children treated at children's hospitals.


CONCLUSIONS
There is considerable variation in the management of pediatric splenic injuries, with significantly lower rates of splenectomy at designated children's hospitals. Quality improvement interventions, including increased education and training for physicians in general hospitals, may be needed to increase the use of spleen-conserving management practices.
Bowman
Stephen M
SM
Department of Health Services, University of Washington, Seattle, USA. smbowman@u.washington.edu
Zimmerman
Frederick J
FJ
Christakis
Dimitri A
DA
Sharar
Sam R
SR
Martin
Diane P
DP
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006769:Hospitals, General / Q000592:standards* / Q000706:statistics & numerical data; D006776:Hospitals, Pediatric / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D013154:Spleen / Q000293:injuries*; D013156:Splenectomy / Q000009:adverse effects / Q000706:statistics & numerical data*; D013530:Surgical Wound Infection / Q000209:etiology; D014481:United States; D014600:Utilization Review