title: Association between pediatric blunt splenic injury volume and the splenectomy rate.
abstract: OBJECTIVE
  While pediatric trauma centers are shown to have lower splenectomy rate as compared to adult trauma centers, it remains unknown whether other institutional factors such as case volumes would have an impact on the splenectomy rate in pediatric blunt splenic injury (BSI).
  
  
  METHODS
  Pediatric patients who sustained BSI were identified from the National Trauma Data Bank 2007-2014. A hierarchical logistic regression model was built to evaluate differences in risk-adjusted splenectomy rate and in-hospital mortality in between trauma centers with different pediatric BSI case volumes.
  
  
  RESULTS
  A total of 7621 children who met criteria were treated at trauma centers with different pediatric BSI case volumes (0-60, 61-120, 121-180, 181-240 cases during 2007-2014 for Group 1, 2, 3, and 4, respectively). High volume centers were shown to have decreased splenectomy rates (odds ratios [OR] 0.50 and 0.64, 95% confidence intervals [CI] 0.30-0.83, 0.44-0.95 for Groups 3 and 4, respectively) with an additional survival benefit in Group 4 (OR 0.452, 95%CI 0.257-0.793) when compared to the lowest volume centers (Group 1).
  
  
  CONCLUSIONS
  Higher pediatric BSI case volume was associated with lower splenectomy rate with an additional survival benefit. Trauma centers' volume in pediatric BSI may be an important factor for the improved splenic preservation.
  
  
  METHODS
  Retrospective comparative study, Level III.
authors.affiliation: Department of Surgery, Children's Hospital Los Angeles, Los Angeles, California; Department of Surgery, Arrowhead Regional Medical Center, Colton, California. Electronic address: drmiyatas@gmail.com.
authors.forename: Shin
authors.initials: S
authors.lastname: Miyata
authors.affiliation: Division of Acute Care Surgery, University of Southern California, Los Angeles, California. Electronic address: jayuncho11@gmail.com.
authors.forename: Jayun
authors.initials: J
authors.lastname: Cho
authors.affiliation: Division of Acute Care Surgery, University of Southern California, Los Angeles, California. Electronic address: Kazuhide.Matsushima@med.usc.edu.
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Matsushima
authors.affiliation: Department of Surgery, Children's Hospital Los Angeles, Los Angeles, California. Electronic address: olga.lebedevskiy@gmail.com.
authors.forename: Olga
authors.initials: O
authors.lastname: Lebedevskiy
authors.affiliation: Department of Surgery, Arrowhead Regional Medical Center, Colton, California. Electronic address: hanna.s.park@gmail.com.
authors.forename: Hanna
authors.initials: H
authors.lastname: Park
authors.affiliation: Department of Surgery, Arrowhead Regional Medical Center, Colton, California. Electronic address: courtney.fortner@gmail.com.
authors.forename: Courtney A
authors.initials: CA
authors.lastname: Fortner
authors.affiliation: Department of Surgery, Children's Hospital Los Angeles, Los Angeles, California. Electronic address: dbliss@chla.usc.edu.
authors.forename: David W
authors.initials: DW
authors.lastname: Bliss
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D016208:Databases, Factual; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D012189:Retrospective Studies; D013154:Spleen / Q000293:injuries* / Q000601:surgery; D013156:Splenectomy / Q000706:statistics & numerical data*; D014193:Trauma Centers; D014949:Wounds, Nonpenetrating / Q000453:epidemiology* / Q000628:therapy*
keywords: Blunt splenic injury; Pediatric trauma; Splenectomy rate; Splenic preservation