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Splenic conservation: variation between pediatric and adult trauma centers
Sarah J Lippert1, Charles W Hartin, Doruk E Ozgediz
1Department of Surgery, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY 14222, USA.
The Journal of Surgical Research
|September 4, 2012
Summary
Adolescent splenic injuries treated at a pediatric trauma center (PTC) had lower splenectomy rates than adult trauma centers (ATC). Location of presentation, not injury severity, independently predicted splenectomy, with no increased length of stay at the PTC.
Area of Science:
- Trauma Surgery
- Pediatric Surgery
- Emergency Medicine
Background:
- Nonoperative management of hemodynamically stable splenic injuries is standard in adolescents.
- Significant variation exists in the management of these injuries.
- Comparing outcomes between pediatric and adult trauma centers is crucial.
Purpose of the Study:
- To compare the treatment and outcomes of adolescent splenic injuries.
- To evaluate the impact of trauma center type (pediatric vs. adult) on management and outcomes.
- To identify factors associated with splenectomy in adolescents with blunt splenic injury.
Main Methods:
- Retrospective review of trauma registry data (1999-2010).
- Inclusion criteria: patients aged 14-17 years with blunt splenic injury.
- Comparison of demographics, interventions, and hospital course between pediatric level I trauma center (PTC) and adult level I trauma center (ATC) using statistical analysis.
Main Results:
- 86 adolescent patients at PTC and 65 at ATC met criteria.
- ATC received more severely injured and slightly older patients.
- Presentation location was the only independent factor associated with splenectomy (P=0.0015); higher injury severity score correlated with longer length of stay (LOS), but nonoperative approach did not increase LOS (P=0.96).
Conclusions:
- Trauma center location independently predicted splenectomy, even when controlling for injury severity.
- Pediatric trauma center management was associated with a higher rate of nonoperative treatment.
- Treatment at a PTC was not linked to increased total or intensive care unit LOS.