title: The pediatric trauma center and the inclusive trauma system: Impact on splenectomy rates.
abstract: BACKGROUND
  Before 2006, the Delaware Trauma System (DTS) did not include a designated pediatric trauma center (PTC). In 2006, the Delaware Trauma System designated and the American College of Surgeons Committee on Trauma verification/consultation program verified Nemours AI DuPont Hospital for Children, a freestanding children's hospital, as a PTC. We evaluated the impact of the addition of the PTC to the state trauma system on pediatric traumatic splenectomy rates.
  
  
  METHODS
  The study cohort comprised DTS trauma registry recorded children younger than 16 years with spleen injury (ICD-9 codes 865.0-865.9) from January 1998 through December 2012. This cohort was categorized into pre-PTC (1998-2005) and post-PTC (2006-2012) groups. Penetrating injuries were excluded. Comparisons between groups included age, gender, length of stay, organ-specific injury grade, Injury Severity Score, incidence of polytrauma, splenectomy rate, and admitting hospital. Management, operative versus nonoperative, of low grade (Organ Injury Scale [OIS] score, 1-3) and high grade (OIS score, 4-5) were also compared. Pearson's χ analysis was performed for categorical variables. Continuous variables were reported as mean (standard deviation) and compared by Student's t test for independent normally distributed samples. Mann-Whitney U-test was used for non-normally distributed variables. A value of p < 0.05 was considered significant.
  
  
  RESULTS
  Of the 231 pediatric spleen injuries, 118 occurred pre-PTC and 113 occurred post-PTC. There were no significant differences in age, gender, length of stay, Injury Severity Score, OIS grade, or incidence of polytrauma. Splenectomy rates decreased from 11% (13 of 118) pre-PTC to 2.7% (3 of 113) post-PTC (p = 0.012).
  
  
  CONCLUSIONS
  The addition of an American College of Surgeons-verified PTC within an inclusive trauma system that was previously without one was associated with a significant reduction in the rate of blunt trauma-related splenectomy. Integration of a verified PTC is an influential factor in achieving spleen preservation rates equivalent to published American Pediatric Surgery Association benchmarks within a trauma system.
  
  
  METHODS
  Therapeutic study, level IV; epidemiologic study, level III.
authors.affiliation: From the Christiana Care Health System (E.E.K.M., M.D.C., G.H.T.), John H. Ammon Medical Education Center, Newark, Delaware; and Nemours AI DuPont Hospital for Children (S.G.M.), Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Emily E K
authors.initials: EE
authors.lastname: Murphy
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Murphy
authors.forename: Mark D
authors.initials: MD
authors.lastname: Cipolle
authors.forename: Glen H
authors.initials: GH
authors.lastname: Tinkoff
mesh_terms: D000007:Abdominal Injuries / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D000293:Adolescent; D002648:Child; D005260:Female; D006776:Hospitals, Pediatric / Q000458:organization & administration*; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D007902:Length of Stay / Q000639:trends; D008297:Male; D012042:Registries; D012189:Retrospective Studies; D013154:Spleen / Q000293:injuries* / Q000601:surgery; D013156:Splenectomy / Q000706:statistics & numerical data*; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers / Q000458:organization & administration*; D014481:United States / Q000453:epidemiology; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D014950:Wounds, Penetrating / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery