title: Trauma center variation in the management of pediatric patients with blunt abdominal solid organ injury: a national trauma data bank analysis.
abstract: BACKGROUND
  Nonoperative management of hemodynamically stable children with Solid Organ Injury (SOI) has become standard of care. The aim of this study is to identify differences in management of children with SOI treated at Adult Trauma Centers (ATC) versus Pediatric Trauma Centers (PTC). We hypothesized that patients treated at ATC would undergo more procedures than PTC.
  
  
  METHODS
  Patients younger than 18 years old with isolated SOI (spleen, liver, kidney) who were treated at level I-II ATC or PTC were identified from the 2011-2012 National Trauma Data Bank. The primary outcome measure was the incidence of operative management. Data was analyzed using multivariate logistic regression analysis. Procedures were defined as surgery or transarterial embolization (TAE).
  
  
  RESULTS
  6799 children with SOI (spleen: 2375, liver: 2867, kidney: 1557) were included. Spleen surgery was performed more frequently at ATC than PTC {101 (7.7%) vs. 52 (4.9%); P=0.007}. After adjusting for potential confounders (grade of injury, age, gender and injury severity score), admission at ATC was associated with higher odds of splenic surgery (OR: 1.5, 95% CI: 1.02-2.25; p=0.03). 11 and 8 children underwent kidney and liver operations respectively. TAE was performed in 17 patients with splenic, 34 with liver and 14 with kidney trauma. There was no practice variation between ATC and PTC regarding kidney and liver operations or TAE incidence.
  
  
  CONCLUSIONS
  Operative management for SOI was more often performed at ATC. The presence of significant disparity in the management of children with splenic injuries justifies efforts to use these surgeries as a reported national quality indicator for trauma programs.
authors.affiliation: Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, AZ, USA.
authors.forename: Arash
authors.initials: A
authors.lastname: Safavi
authors.affiliation: Division of Pediatric General Surgery, BC Children's Hospital and University of British Columbia, Vancouver, BC, Canada.
authors.forename: Erik D
authors.initials: ED
authors.lastname: Skarsgard
authors.affiliation: Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, AZ, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Rhee
authors.affiliation: Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, AZ, USA.
authors.forename: Bardiya
authors.initials: B
authors.lastname: Zangbar
authors.affiliation: Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, AZ, USA.
authors.forename: Narong
authors.initials: N
authors.lastname: Kulvatunyou
authors.affiliation: Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, AZ, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Tang
authors.affiliation: Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, AZ, USA.
authors.forename: Terence
authors.initials: T
authors.lastname: O'Keeffe
authors.affiliation: Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, AZ, USA.
authors.forename: Randall S
authors.initials: RS
authors.lastname: Friese
authors.affiliation: Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, AZ, USA. Electronic address: bjoseph@surgery.arizona.edu.
authors.forename: Bellal
authors.initials: B
authors.lastname: Joseph
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007668:Kidney / Q000293:injuries* / Q000601:surgery; D008099:Liver / Q000293:injuries* / Q000601:surgery; D016015:Logistic Models; D008297:Male; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013154:Spleen / Q000293:injuries* / Q000601:surgery; D014193:Trauma Centers / Q000706:statistics & numerical data*; D014481:United States; D014949:Wounds, Nonpenetrating / Q000601:surgery* / Q000628:therapy
keywords: Kidney; Liver; Pediatric trauma; Spleen