Impact of a statewide quality improvement initiative in improving the management of pediatric splenic injuries in washington state.
BACKGROUND
Evidence suggests that 90% of children with traumatic spleen injuries can be successfully managed nonoperatively. In Washington State, significant interhospital variation in pediatric spleen management led to the development and implementation of a statewide quality improvement initiative in 2002. We evaluated pediatric splenic injury management before and after the implementation of a statewide quality improvement initiative.


METHODS
Retrospective cohort study using data from the Washington Trauma Registry for years 1999-2001 (preintervention) and 2003-2005 (postintervention). Children ages 0 to 14 years who were hospitalized with a traumatic (noniatrogenic) splenic injury were included. Multivariable regression was used to control for patient and hospital characteristics.


RESULTS
Splenectomies were more common, occurring in 13.6% of children, in the preintervention period, compared with 7.8% in the postintervention period (p = 0.027). After adjusting for patient, injury, and hospital characteristics, children remained less likely to receive a splenectomy in the postintervention period than in the preintervention period (odds ratio 0.39, 95% confidence interval 0.19-0.82). Children cared for at pediatric trauma hospitals were less likely to receive splenectomy in both the preintervention and postintervention periods, compared with children treated at general trauma hospitals (p < 0.001). Splenectomy remained less common among children treated at pediatric-designated hospitals (odds ratio, 0.21; 95% confidence interval, 0.08-0.58) than among children treated in general trauma hospitals after controlling for intervention period.


CONCLUSIONS
The statewide quality improvement initiative was associated with a reduction in the rate of splenectomy in both pediatric and general trauma hospitals. However, general trauma hospitals remained more likely to perform splenectomies than hospitals with pediatric trauma designation.
Departments of Health Services, University of Washington, Olympia, Washington, USA. bowmanStephenM@vams.edu
Stephen M
SM
Bowman
Sam R
SR
Sharar
Linda
L
Quan
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004621:Embolization, Therapeutic / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D015601:Injury Severity Score; D008297:Male; D015999:Multivariate Analysis; D012042:Registries; D012044:Regression Analysis; D012189:Retrospective Studies; D012308:Risk Management; D013154:Spleen / Q000293:injuries*; D013156:Splenectomy / Q000379:methods / Q000706:statistics & numerical data*; D013161:Splenic Rupture / Q000175:diagnosis / Q000628:therapy*; D017749:Total Quality Management; D014193:Trauma Centers; D016896:Treatment Outcome; D014861:Washington