Related Experiment Video
Updated: Aug 15, 2026
A Saline/Bipolar Radiofrequency Energy Device As an Adjunct for Hemostasis in Solid Organ Injury/Trauma
Published on: July 28, 2020
Changing patterns of treatment for blunt splenic injuries: an 11-year experience in a rural state
1University of Vermont College of Medicine, the Department of Surgery, Fletcher Allen Health Care, Burlington 05401, USA.
Insights
The nonoperative management (NOM) rate for pediatric blunt splenic injuries increased significantly from 1985-1995. While pediatric trauma centers (PTCs) maintained higher NOM rates, more children were treated at regional hospitals (RH), increasing overall surgery rates.
Area of Science:
- Trauma Surgery
- Pediatric Surgery
- Public Health
Background:
- Blunt splenic injuries are common in pediatric trauma.
- Management trends and outcomes vary between specialized centers and regional hospitals.
Purpose of the Study:
- To evaluate trends in pediatric blunt splenic injury management in a rural state.
- To compare management strategies between pediatric trauma centers (PTCs) and regional hospitals (RH).
Main Methods:
- Population-based review of ICD-9-CM codes for pediatric splenic injuries (1985-1995).
- Comparison of nonoperative management (NOM) rates, hospital charges, and patient demographics between PTCs and RHs.
- Statistical analysis using chi-squared and linear regression.
Main Results:
- Overall NOM rate increased from 21% to 64.2% during the study period.
- PTCs had higher NOM rates (54.3%) than RHs (35.9%).
- NOM rates significantly increased in both PTCs and RHs, but RHs saw more children treated overall in later years.
Conclusions:
- Nonoperative management of pediatric blunt splenic injuries has significantly increased.
- Pediatric trauma centers consistently demonstrate higher NOM rates.
- Despite educational efforts, regional hospitals lag in NOM, leading to increased surgical rates in the overall pediatric population.
Purpose:
The aim of this study was to perform a population-based study evaluating the trend in management of pediatric blunt splenic injuries in a rural state and assess differences in the management of those injuries at a level I pediatric trauma center (PTC) and regional hospitals (RH) from 1985 through 1995.
Methods:
ICD-9-CM diagnosis and procedure codes for children (age less than 19) discharged from all hospitals in a rural state with splenic injuries from 1985 through 1995 were reviewed. Hospital charges, age, and nonoperative management (NOM) rates were calculated for PTC and RH and compared using chi2 and linear regression. (P < .05 is statistically significant.) Patients were divided into 2 groups; G1, 1985 through 1989 (127 children); G2, 1990 through 1995 (140 children).
Results:
The overall NOM rate increased from 21% (G1) to 64.2% (G2), P < .001. A total of 114 patients were treated at PTC and 153 patients received care at RH. PTC had a NOM rate of 54.3% versus 35.9% at RH (P = .003). There was no statistical difference in ages or ISS within the groups or between PTC and RH. NOM in RH rose from 7.7% in G1 to 56.9% in G2 (P < .000), and from 35.5% in G1 to 76.9% in G2 (P < .001) for PTC. Hospital charges were lower for patients receiving NOM versus those with surgical treatment of their injury, $8,094 versus $10,862 (P = .018). However, a higher percentage of children were treated at RH than PTC in G2 versus G1 (68.2% v 51.2%, P = .0541).
Conclusions:
Over the 10-year period studied, the NOM rate for splenic injuries significantly decreased. This trend was seen at both the PTC and RH, but the PTC maintained a higher rate of NOM. Unfortunately, more children were treated at RH in G2. Educational programs increased NOM in RH but not to a level equal to PTC. These programs had the negative effect of allowing more children to be treated at RH, actually increasing the splenic operation rate for this population.
