title: Variation in treatment of blunt splenic injury in Dutch academic trauma centers.
abstract: BACKGROUND
  The incidence of splenectomy after trauma is institutionally dependent and varies from 18% to as much as 40%. This is important because variation in management influences splenic salvage. The aim of this study was to investigate whether differences exist between Dutch level 1 trauma centers with respect to the treatment of these injuries, and if variation in treatment was related to splenic salvage, spleen-related reinterventions, and mortality.
  
  
  METHODS
  Consecutive adult patients who were admitted between January 2009 and December 2012 to five academic level 1 trauma centers were identified. Multinomial logistic regression was used to measure the influence of hospital on treatment strategy, controlling for hemodynamic instability on admission, high grade (American Association for the Surgery of Trauma 3-5) splenic injury, and injury severity score. Binary logistic regression was used to quantify differences among hospitals in splenic salvage rate.
  
  
  RESULTS
  A total of 253 patients were included: 149 (59%) were observed, 57 (23%) were treated with splenic artery embolization and 47 (19%) were operated. The observation rate was comparable in all hospitals. Splenic artery embolization and surgery rates varied from 9%-32% and 8%-28%, respectively. After adjustment, the odds of operative management were significantly higher in one hospital compared with the reference hospital (adjusted odds ratio 4.98 [1.02-24.44]). The odds of splenic salvage were significantly lower in another hospital compared with the reference hospital (adjusted odds ratio 0.20 [0.03-1.32]).
  
  
  CONCLUSIONS
  Although observation rates were comparable among the academic trauma centers, embolization and surgery rates varied. A nearly 5-fold increase in the odds of operative management was observed in one hospital, and another hospital had significantly lower odds of splenic salvage. The development of a national guideline is recommended to minimalize splenectomy after trauma.
authors.affiliation: Trauma Unit, Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Dominique C
authors.initials: DC
authors.lastname: Olthof
authors.affiliation: Trauma Unit, Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Jan S K
authors.initials: JS
authors.lastname: Luitse
authors.affiliation: Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
authors.forename: Philippe P
authors.initials: PP
authors.lastname: de Rooij
authors.affiliation: Department of Surgery, University Medical Centre, Utrecht, The Netherlands.
authors.forename: Loek P H
authors.initials: LP
authors.lastname: Leenen
authors.affiliation: Department of Surgery, University Medical Centre Groningen, Groningen, The Netherlands.
authors.forename: Klaus W
authors.initials: KW
authors.lastname: Wendt
authors.affiliation: Department of Surgery, VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: Frank W
authors.initials: FW
authors.lastname: Bloemers
authors.affiliation: Trauma Unit, Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands. Electronic address: j.c.goslings@amc.nl.
authors.forename: J Carel
authors.initials: JC
authors.lastname: Goslings
mesh_terms: D000328:Adult; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D013154:Spleen / Q000293:injuries*; D014193:Trauma Centers; D014949:Wounds, Nonpenetrating / Q000628:therapy*
keywords: Blunt splenic injury; Splenic salvage; Treatment variation