title: Trauma center variation in splenic artery embolization and spleen salvage: a multicenter analysis.
abstract: BACKGROUND
  This study aimed to evaluate if variation in management of blunt splenic injury (BSI) among Level I trauma centers is associated with different outcomes related to the use of splenic artery embolization (SAE).
  
  
  METHODS
  All adult patients admitted for BSI from 2008 to 2010 at 4 Level I trauma centers were reviewed. Use of SAE was determined, and outcomes of spleen salvage and nonoperative management (NOM) failure were evaluated. A priori, a 10% SAE rate was used to group centers into high- or low-use groups.
  
  
  RESULTS
  There were 1,275 BSI patients. There were intercenter differences in age, injury severity, and grade of spleen injury (Spleen Injury Scale [SIS]). Mortality was similar by center; however, BSI treatment varied significantly by center. Overall, SAE use was highest at center A compared with B, C, and D (19%, 11%, 1%, and 4%, respectively; p < 0.01). High SAE use centers had significantly higher spleen salvage rates and fewer NOM failures. Differences in the use of SAE (25% vs. 2%, p < 0.01) and salvage rate (67% vs. 56%, p = 0.03) were most dramatic between high- and low-use SAE centers for Grade 3 and 4 injured spleens. In patients who received initial NOM, multivariate logistic regression analysis showed that SAE was an independent predictor of spleen salvage (odds ratio, 5; 95% confidence interval, 1.8-13.5; p < 0.01) as were lower age, lower SIS, and Injury Severity Score (ISS). Patients treated at high SAE use centers were more likely to leave the hospital with their spleen in situ (odds ratio, 3; 95% confidence interval, 1.7-6.3; p < 0.01).
  
  
  CONCLUSIONS
  Significant practice variation exists in the use of SAE in treating BSI at Level I trauma centers. Centers with higher rates of SAE use have higher spleen salvage and less NOM failure. SAE was shown to be an independent predictor of spleen salvage.
  
  
  METHODS
  Therapeutic study, level IV.
authors.affiliation: MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio 44109-1998, USA.
authors.forename: Aman
authors.initials: A
authors.lastname: Banerjee
authors.forename: Therese M
authors.initials: TM
authors.lastname: Duane
authors.forename: Sean P
authors.initials: SP
authors.lastname: Wilson
authors.forename: Starre
authors.initials: S
authors.lastname: Haney
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: O'Neill
authors.forename: Heather L
authors.initials: HL
authors.lastname: Evans
authors.forename: John J
authors.initials: JJ
authors.lastname: Como
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Claridge
mesh_terms: D000328:Adult; D015331:Cohort Studies; D016001:Confidence Intervals; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D018570:Risk Assessment; D016879:Salvage Therapy; D013154:Spleen / Q000098:blood supply / Q000293:injuries*; D013156:Splenectomy / Q000379:methods / Q000401:mortality; D013157:Splenic Artery; D015996:Survival Rate; D014193:Trauma Centers / Q000592:standards*; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*