title: Variability in pediatric splenic injury care: results of a national survey of general surgeons.
abstract: BACKGROUND
  Although nonoperative management is the standard of care for hemodynamically stable children with blunt splenic trauma, significant variation in practice exists. Little attention has been given to physician factors associated with management differences.
  
  
  METHODS
  Nationally representative mail survey conducted in June 2008.
  
  
  METHODS
  United States.
  
  
  METHODS
  Ten percent random sample of active, dues-paying fellows in the American College of Surgeons.
  
  
  METHODS
  Knowledge, attitudes, and beliefs toward pediatric splenic injury management, including the role of clinical practice guidelines.
  
  
  RESULTS
  Almost all of the 375 responding surgeons (97.4%) agreed that surgical intervention is not immediately necessary for hemodynamically stable children. However, surgeons reported significant disagreement regarding whether blood should be administered before operative intervention for hemodynamically unstable children and whether explorative surgery is needed for stable patients with evidence of contrast extravasation on computed tomography. Only 18.7% of surgeons reported being very familiar with the clinical practice guidelines for the management of pediatric blunt splenic trauma from either the Eastern Association for the Surgery of Trauma or the American Pediatric Surgical Association. Surgeons who were very familiar with either guideline were significantly more likely to rate the guidelines as beneficial (90.0% vs 72.8%, P = .002).
  
  
  CONCLUSIONS
  General surgeons reported varying degrees of familiarity with and use of clinical practice guidelines for pediatric splenic injury management. Limited pediatric experience and lack of pediatric hospital resources may limit more widespread adoption of nonoperative management. Targeted educational interventions may help increase surgeon knowledge of guidelines and best practices.
authors.affiliation: Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, USA. smbowman@jhsph.edu
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Bowman
authors.forename: Eileen
authors.initials: E
authors.lastname: Bulger
authors.forename: Sam R
authors.initials: SR
authors.lastname: Sharar
authors.forename: Sabrina A
authors.initials: SA
authors.lastname: Maham
authors.forename: Samuel D
authors.initials: SD
authors.lastname: Smith
mesh_terms: D001803:Blood Transfusion / Q000706:statistics & numerical data; D005119:Extravasation of Diagnostic and Therapeutic Materials; D019983:Guideline Adherence; D007722:Health Knowledge, Attitudes, Practice; D006439:Hemodynamics; D006801:Humans; D016015:Logistic Models; D010372:Pediatrics / Q000379:methods*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D013154:Spleen / Q000293:injuries*; D013156:Splenectomy / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014057:Tomography, X-Ray Computed; D014481:United States / Q000453:epidemiology; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*