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Variation in specialists' reported hospitalization practices of children sustaining blunt abdominal trauma

Peter E Sokolove1, Nathan Kuppermann, Cheryl W Vance

  • 1University of California Davis, Department of Emergency Medicine, Davis, California.

The Western Journal of Emergency Medicine
|March 1, 2013
PubMed

Insights

Physician specialty significantly impacts decisions for discharging children with blunt abdominal trauma (BAT) and minor CT findings. More evidence is needed to standardize care for these patients.

Area of Science:

  • Pediatric Emergency Medicine
  • Trauma Surgery
  • Radiology

Background:

  • Children with blunt abdominal trauma (BAT) often face hospitalization without intervention.
  • Discrepancies exist in emergency department (ED) disposition for pediatric BAT cases.
  • Computed tomography (CT) findings play a role in disposition decisions.

Purpose of the Study:

  • To identify factors influencing ED disposition for children with BAT.
  • To examine how varying CT findings affect disposition preferences among physicians.
  • To understand specialty-specific variations in managing pediatric blunt abdominal trauma.

Main Methods:

  • Surveyed pediatric and general emergency physicians (EPs) and pediatric/trauma surgeons.
  • Presented two hypothetical pediatric BAT cases with different CT findings.
  • Analyzed disposition preferences using multivariable regression, controlling for clinical and hospital factors.

Main Results:

  • For normal CT scans, 99% (Case 1) and 88% (Case 2) of physicians would discharge patients.
  • Trace intraperitoneal fluid (TIF) led to lower discharge rates by pediatric surgeons (OR 0.52-0.49).
  • Renal contusions decreased discharge likelihood by pediatric surgeons but increased it by general EPs (OR 0.55-2.37).

Conclusions:

  • Significant inter-specialty variation exists in hospitalization practices for pediatric BAT.
  • Asymptomatic children with minor CT findings show differing management based on physician specialty.
  • Evidence-based guidelines are necessary to standardize disposition decisions for pediatric blunt abdominal trauma.
Abstract

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