title: Benchmarks for splenectomy in pediatric trauma: how are we doing?
abstract: OBJECTIVE
  Following publication of American Pediatric Surgical Association (APSA) hospital benchmarks for the operative management of blunt splenic trauma in specialized centers, it was found that most hospitals exceeded these benchmarks. We sought to determine if benchmarks were being met a decade later and to identify factors associated with splenectomy in injured children.
  
  
  METHODS
  Rates of splenic procedures were calculated for children≤19 with a blunt splenic injury (ICD-9 865) using the 2010-2011 National Trauma Data Bank. Multivariable analysis was performed to determine independent predictors of splenectomy.
  
  
  RESULTS
  Of 8597 children, 24.3% received care at pediatric trauma centers (PTC), 34.6% at adult trauma centers (ATC), and the remaining 41.2% at other centers (OTC). The overall operative rate was 9.2% (3.9% if age≤14, 6.7% if ≤17). Operative rates were higher in children treated at ATC and OTC when compared to PTC. On multivariable analysis, age>14, coexisting injuries, severity of splenic injury, and care at ATC or OTC were predictive of undergoing operative treatment.
  
  
  CONCLUSIONS
  Operative rates for splenic injuries meet APSA benchmarks at PTC yet remain high at other centers. Care at an ATC or OTC is associated with greater odds of operative management after adjustment for age and injury severity.
authors: Department of Surgery, Mayo Clinic, Rochester, MN.
authors: Stephanie F
authors: SF
authors: Polites
authors: Department of Surgery, Mayo Clinic, Rochester, MN.
authors: Martin D
authors: MD
authors: Zielinski
authors: Department of Surgery, Mayo Clinic, Rochester, MN.
authors: Abdalla E
authors: AE
authors: Zarroug
authors: Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.
authors: Amy E
authors: AE
authors: Wagie
authors: Department of Surgery, Columbia University College of Physicians & Surgeons, Division of Pediatric Surgery, Morgan Stanley Children's Hospital of New York-Presbyterian, New York, NY.
authors: Steven
authors: S
authors: Stylianos
authors: Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN. Electronic address: habermann.elizabeth@mayo.edu.
authors: Elizabeth B
authors: EB
authors: Habermann
mesh_terms: D000007:Abdominal Injuries / Q000601:surgery*; D000293:Adolescent; D019985:Benchmarking / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D019468:Disease Management; D005260:Female; D006801:Humans; D008297:Male; D013154:Spleen / Q000293:injuries* / Q000601:surgery; D013156:Splenectomy / Q000379:methods*; D014193:Trauma Centers; D014949:Wounds, Nonpenetrating / Q000601:surgery*; D055815:Young Adult
keywords: Pediatric trauma; Spleen; Splenectomy