Evolution, not revolution: splenic salvage for blunt trauma in a statewide voluntary trauma system--a 10-year experience.
BACKGROUND
State-legislated trauma systems have been enacted in an attempt to improve trauma care. Blunt splenic injury incidence without a legislated trauma system was examined for changes in care with a hypothesis that a voluntary system may perform equally with a legislated system.


METHODS
Data from a statewide discharge database for the years 1993 to 2002 were examined.


RESULTS
There were 276,425 trauma admissions overall, with blunt splenic injury occurring in 1.76%. Average Injury Severity Score (ISS) increased in trauma centers and decreased in the community. Trauma centers (TC) had more multisystem injuries. Splenic injury diagnosis increased 44% in TC between the early and late periods but only 7% in community facilities. Splenectomies increased 16% in TC but declined 16% in community hospital. Splenic salvage rate improved at both types of facilities.


CONCLUSIONS
Splenic salvage rates improved over time in hospitals with no formal trauma system. Community hospitals cared for more than 50% of splenic injuries but transferred complex multisystem injuries, including splenic injuries, suggesting evolving care. Non-invasive imaging has increased the recognition of splenic injuries in both community hospitals and TC. Splenectomies are performed less, but have increased in TC with increasing ISS scores.
Bjerke
Scott
S
Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA. sbjerke@clarian.org
Pohlman
Timothy
T
Saywell
Robert M
RM
Przybylski
Michael P
MP
Rodman
George H
GH
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006764:Hospitals, Community / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D007196:Indiana / Q000453:epidemiology; D007223:Infant; D015601:Injury Severity Score; D007813:Laparotomy / Q000706:statistics & numerical data; D007902:Length of Stay; D008297:Male; D008331:Management Information Systems; D017063:Outcome Assessment, Health Care / Q000379:methods; D017009:Professional Autonomy; D012041:Regional Medical Programs; D013154:Spleen / Q000293:injuries* / Q000601:surgery; D013156:Splenectomy / Q000706:statistics & numerical data; D014193:Trauma Centers / Q000592:standards* / Q000706:statistics & numerical data; D014949:Wounds, Nonpenetrating / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*