title: Variation in the use of urgent splenectomy after blunt splenic injury in adults.
abstract: OBJECTIVE
  Recent reports indicate that mortality after trauma center admission may be directly related to the rate of operative intervention after blunt solid organ injury. These findings bring into question the role of urgent splenectomy after blunt splenic injury (BSI). The purpose of this study was to determine the role of urgent splenectomy (defined as splenectomy within 6 hours of admission) in the management of BSI as well as the relationship between urgent splenectomy and in-hospital mortality.
  
  
  METHODS
  The National Trauma Data Bank for 2007 was queried for adults (18-81) who suffered BSI. Patients who died in or were transferred from the emergency department were excluded. Hierarchical multivariate models were used to account for clustering of patients within hospitals and to identify hospital and patient factors associated with urgent splenectomy. Propensity score matching was used to analyze the relationship between urgent splenectomy and mortality.
  
  
  RESULTS
  There were 507,202 total incidents identified. Of those, 11,793 met inclusion criteria. Urgent splenectomy was performed on 1,104 (9.4%). Hierarchical models revealed that age ≥55 years, arrival systolic blood pressure ≤90 mm Hg, no or mild head injury, increasing injury severity, and massive disruption of the spleen were associated with urgent splenectomy. Hospitals level factors associated with urgent splenectomy included hospital region, hospital type, and trauma center level. The propensity-matched cohorts revealed no association between urgent splenectomy and in-hospital mortality (odds ratio, 1.08; 95% confidence interval, 0.82-1.42).
  
  
  CONCLUSIONS
  Despite ongoing variation in the use of urgent splenectomy after BSI in adults, urgent splenectomy was not associated with in-hospital mortality.
authors.affiliation: Division of Trauma and Critical Care, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee 38163, USA. bzarzaur@uthsc.edu
authors.forename: Ben L
authors.initials: BL
authors.lastname: Zarzaur
authors.forename: Martin A
authors.initials: MA
authors.lastname: Croce
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Fabian
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D004630:Emergencies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D057216:Propensity Score; D012044:Regression Analysis; D012307:Risk Factors; D013154:Spleen / Q000293:injuries* / Q000601:surgery*; D013156:Splenectomy / Q000379:methods*; D014193:Trauma Centers; D014481:United States / Q000453:epidemiology; D014949:Wounds, Nonpenetrating / Q000401:mortality / Q000601:surgery*