The role of hospital profit status in pediatric spleen injury management.
BACKGROUND
Evidence suggests that over 90% of pediatric splenic injuries can be successfully managed nonoperatively. Although pediatric hospitals have rapidly adopted nonoperative management, variability exists among other types of hospitals.


OBJECTIVE
We tested 2 a priori hypotheses: (1) spleen-injured children are more likely to receive splenectomy in for-profit hospitals than in not-for-profit hospitals; and (2) hospital charges for spleen cases are greater in for-profit hospital than in not-for-profit hospitals.


METHODS
Multivariable regression was performed with data from the Kid's Inpatient Database (KID) for years 2000 and 2003, controlling for patient and hospital characteristics. Children (0-18 years) hospitalized with a blunt traumatic (noniatrogenic) spleen injury in any of the states participating in KID (N = 5061), including adult and pediatric hospitals. Main outcome measures were splenectomy and hospital charges.


RESULTS
A total of 756 children (14.9%) received splenectomies within 1 day of arrival. Splenectomy was found to be more likely among children treated at for-profit hospitals [odds ratio (OR), 1.75; 95% confidence interval (CI), 1.14-2.67] than among children treated in not-for-profit general hospitals. Splenectomies were much less common in children's hospitals (OR, 0.14; 95% CI, 0.05-0.41) than in not-for-profit general hospitals. Hospital charges for all spleen-injured children (regardless of treatment) were significantly greater in for-profit hospitals than in not-for-profit hospitals.


CONCLUSIONS
For-profit hospitals seem to be trailing not-for-profit hospitals in the adoption of spleen-conserving management practices. The cost of caring for a child with a splenic injury also seems greater at for-profit hospitals, regardless of management path (ie, splenectomy vs. nonoperative management).
Bowman
Stephen M
SM
Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72202-3591, USA. bowmanstephenm@uams.edu
Zimmerman
Frederick J
FJ
Christakis
Dimitri A
DA
Sharar
Sam R
SR
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D017722:Hospital Charges / Q000458:organization & administration; D006769:Hospitals, General / Q000191:economics / Q000458:organization & administration*; D006776:Hospitals, Pediatric / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D007223:Infant; D008297:Male; D009939:Organizations, Nonprofit / Q000706:statistics & numerical data*; D013154:Spleen / Q000293:injuries*; D013156:Splenectomy / Q000191:economics / Q000706:statistics & numerical data; D014481:United States; D014600:Utilization Review