Management differences for pediatric solid organ injuries in a rural state.
Pediatric liver and spleen injuries are frequently treated in specialized hospitals. Not all injured children, however, are treated in referral centers. We evaluated the management of pediatric liver and spleen injuries in a rural state without a state trauma system to determine if differences existed between trauma centers and nontrauma centers. A state database was queried for patients < or = 15-years-old who suffered liver and spleen injuries from 2003 to 2005. Iatrogenic injuries were excluded. There were 115 pediatric liver and 183 pediatric spleen injuries. Fifty per cent of liver and 63 per cent of spleen injuries in nontrauma centers were isolated solid organ injuries compared with 18 per cent and 36 per cent, respectively, in trauma centers. The mortality rate for both liver and spleen injuries was similar in trauma and nontrauma centers. Hospital charges were higher in trauma centers but this was due to patients with associated injuries. The nonoperative management rate was similar for liver injuries. Pediatric patients with splenic injuries had a lower rate of nonoperative management in nontrauma centers (75% to 90%, nontrauma vs trauma). In Kentucky, pediatric solid organ injuries are usually managed nonoperatively in both trauma and nontrauma centers, but trauma centers cared for fewer isolated solid organ injuries.
Harbrecht
Brian G
BG
Department of Surgery, University of Louisville, Louisville, Kentucky, USA. briang.harbrecht@louisville.edu
Franklin
Glen A
GA
Smith
Jason W
JW
Foley
David S
DS
Miller
Frank B
FB
Richardson
J David
JD
D002648:Child; D015331:Cohort Studies; D004636:Emergency Service, Hospital; D005260:Female; D050723:Fractures, Bone / Q000175:diagnosis / Q000628:therapy; D006780:Hospitals, Rural; D006801:Humans; D007629:Kentucky; D007902:Length of Stay; D008099:Liver / Q000293:injuries*; D008297:Male; D009104:Multiple Trauma / Q000175:diagnosis* / Q000628:therapy*; D012189:Retrospective Studies; D013154:Spleen / Q000293:injuries*; D016896:Treatment Outcome