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Published on: November 4, 2022
Hospital characteristics associated with the management of pediatric splenic injuries
Stephen M Bowman1, Frederick J Zimmerman, Dimitri A Christakis
1Department of Health Services, University of Washington, Seattle, USA. smbowman@u.washington.edu
Insights
Children with spleen injuries are less likely to have splenectomy at children's hospitals compared to general hospitals. This highlights a quality of care gap in managing pediatric splenic trauma.
Area of Science:
- Pediatric Surgery
- Trauma Care
- Health Services Research
Background:
- Nonoperative management is successful for over 90% of pediatric spleen injuries.
- Splenectomy increases the risk of overwhelming postsplenectomy infection in children.
- Variation in splenectomy rates suggests potential quality of care disparities.
Purpose of the Study:
- To investigate if children with traumatic spleen injuries are more likely to undergo splenectomy in general hospitals versus children's hospitals.
Main Methods:
- Retrospective cohort study utilizing the 2000 Kid's Inpatient Database (KID).
- Analysis included 2851 children (0-16 years) with traumatic spleen injuries.
- Multivariable regression controlled for patient and hospital factors.
Main Results:
- Splenectomy rates were 3% in children's hospitals vs. 15.4% in general hospitals.
- Children's hospitals had significantly lower splenectomy rates (P<.001).
- Adjusted analysis showed splenectomy was 5 times more likely in general hospitals (OR, 5.01).
Conclusions:
- Significant variation exists in pediatric spleen injury management.
- Children's hospitals demonstrate lower splenectomy rates, indicating better spleen-conserving care.
- Quality improvement initiatives are needed in general hospitals to promote nonoperative management.
Context:
Despite evidence that more than 90% of children with traumatic injuries to the spleen can be successfully managed nonoperatively, there is significant variation in the use of splenectomy. As asplenic children are at increased risk of overwhelming postsplenectomy infection, nonoperative management may be considered a quality of care indicator.
Objective:
To test the hypothesis that children are more likely to undergo splenectomy in general hospitals than in children's hospitals.
Design:
Retrospective cohort study using data from the Kid's Inpatient Database (KID) for the year 2000. Multivariable regression was used to control for patient and hospital characteristics.
Setting And Participants:
All children aged 0 to 16 years who were hospitalized with a traumatic (noniatrogenic) spleen injury in nonfederal short-stay hospitals in any of the 27 states participating in KID (N = 2851).
Main Outcome Measure:
Splenectomy performed within 1 day of arrival.
Results:
A total of 11 children (3%) with splenic injuries receiving care at children's hospitals underwent splenectomy compared with 383 children (15.4%) cared for at general hospitals (P<.001). After adjusting for patient characteristics, injury severity, and hospital characteristics, splenectomy was more likely among children treated at general hospitals (odds ratio, 5.01; 95% confidence interval, 2.21-11.36) than among children treated at children's hospitals.
Conclusions:
There is considerable variation in the management of pediatric splenic injuries, with significantly lower rates of splenectomy at designated children's hospitals. Quality improvement interventions, including increased education and training for physicians in general hospitals, may be needed to increase the use of spleen-conserving management practices.
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