title: Clinical practice guidelines (CPGs) reduce costs in the management of isolated splenic injuries at pediatric trauma centers.
abstract: OBJECTIVE
  The American Pediatric Surgical Association Trauma Committee proposed the use of a clinical practice guideline (CPG) for the non-operative management of isolated splenic injuries in 1998. An analysis was conducted to determine the financial impact of CPGs on the management of these injuries.
  
  
  METHODS
  The Pediatric Health Information System database, which contains data from 44 children's hospitals, was used to identify children who sustained a graded isolated splenic injury between June 2005 and June 2010. Demographics, length of stay (LOS), readmission rates, and laboratory, imaging, procedural, and total cost data were determined for all hospitals verified as a pediatric trauma center by the American College of Surgeons and/or designated by their local authority. Comparisons were made between facilities self-identifying as having a splenic injury management CPG and those without a CPG.
  
  
  RESULTS
  Children (1,154) with isolated splenic injuries (grades 1-4) were cared for in 26 pediatric trauma centers: 20 with a CPG and 6 without (non-CPG). Median costs were significantly lower at CPG than non-CPG centers for imaging (US $163 vs. US $641, P < .001), laboratory (US $629 vs. US $1,044, P < .001), and total hospital stay (US $9,868 vs. US $10,830, P < .001). The median LOS for CPG and non-CPG centers were similar (3 vs. 2 days, P = .38), as were readmission rates within 90 days (3.1 vs. 5.1 %, P = .21). Multiple linear regression indicated that LOS (P < .001) and utilization of a CPG (P = .007) are significant independent predictors of total cost.
  
  
  CONCLUSIONS
  Utilization of a CPG to manage children with isolated splenic injuries at a pediatric trauma center results in significantly reduced imaging, laboratory, and total hospital costs independent of patient age, gender, grade, and LOS.
authors.affiliation: Department of Surgery, Children's Hospital Boston and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
authors.forename: Ivan M
authors.initials: IM
authors.lastname: Gutierrez
authors.forename: David
authors.initials: D
authors.lastname: Zurakowski
authors.forename: Qiaoli
authors.initials: Q
authors.lastname: Chen
authors.forename: David P
authors.initials: DP
authors.lastname: Mooney
mesh_terms: D000293:Adolescent; D016009:Chi-Square Distribution; D002648:Child; D003365:Costs and Cost Analysis; D003952:Diagnostic Imaging / Q000191:economics; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay / Q000706:statistics & numerical data; D016014:Linear Models; D008297:Male; D010359:Patient Readmission / Q000706:statistics & numerical data; D010372:Pediatrics / Q000191:economics*; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D013154:Spleen / Q000293:injuries*; D018709:Statistics, Nonparametric; D014193:Trauma Centers / Q000191:economics*; D014949:Wounds, Nonpenetrating / Q000191:economics* / Q000628:therapy*