Benchmarks for splenectomy in pediatric trauma: how are we doing?

Area of Science:

• Pediatric Surgery
• Trauma Management
• Surgical Outcomes

Background:

• American Pediatric Surgical Association (APSA) established hospital benchmarks for blunt splenic trauma management.
• Initial findings indicated most hospitals exceeded these benchmarks.
• A decade later, re-evaluation was needed to assess current practices.

Purpose of the Study:

• To determine if pediatric blunt splenic trauma operative rates meet APSA benchmarks a decade after their publication.
• To identify factors associated with splenectomy in injured children.

Main Methods:

• Analysis of the 2010-2011 National Trauma Data Bank for children (≤19 years) with blunt splenic injury (ICD-9 865).
• Calculation of splenic procedure rates across different trauma center types: pediatric (PTC), adult (ATC), and other (OTC).
• Multivariable analysis to identify predictors of splenectomy.

Main Results:

• Of 8597 children, 24.3% were treated at PTC, 34.6% at ATC, and 41.2% at OTC.
• Overall operative rate was 9.2%, with variations by age (3.9% if ≤14, 6.7% if ≤17).
• Operative rates were significantly higher at ATC and OTC compared to PTC. Age >14, coexisting injuries, splenic injury severity, and treatment at ATC/OTC predicted operative management.

Conclusions:

• Pediatric trauma centers (PTC) generally meet APSA benchmarks for operative splenic injury rates.
• Higher operative rates persist at adult trauma centers (ATC) and other centers (OTC).
• Treatment at ATC or OTC is associated with increased odds of operative management, even after adjusting for age and injury severity.