Related Experiment Video
Updated: Jul 25, 2025
Bloodless Laparoscopic Partial Splenectomy Assisted by Bipolar Radiofrequency Excision Hemostatic Device
Published on: November 4, 2022
Treatment of Severe Blunt Splenic Injury Varies Across Race and Insurance Type of Pediatric Patients
Zachary T Sheff1, Abbie Zhang2, Karla Geisse3
1Peyton Manning Children's Hospital, Indianapolis, Indiana.
Insights
Racial disparities exist in pediatric blunt splenic injury (BSI) management. Black children are less likely to receive preferred nonoperative management (NOM), highlighting a need for further investigation into care inequities.
Area of Science:
- Trauma Surgery
- Pediatric Surgery
- Health Disparities Research
Background:
- Racial and ethnic disparities in adult blunt splenic injury (BSI) management are documented.
- It remains unclear if similar disparities affect pediatric BSI patient care.
- Nonoperative management (NOM) is the preferred approach for BSIs.
Purpose of the Study:
- To assess the association between race and insurance status with NOM utilization in pediatric patients (<18 years) with BSIs.
- To identify potential disparities in the management of pediatric blunt splenic injuries.
- To analyze secondary outcomes such as blood transfusion rates and hospital length of stay.
Main Methods:
- Data were extracted from the American College of Surgeons Trauma Quality Improvement Program (2013-2017).
- Multivariate logistic regression analyzed associations between race/insurance and NOM, controlling for injury severity, age, and facility type.
- Secondary outcomes included 24-hour blood transfusion and hospital length of stay.
Main Results:
- Black, non-Hispanic pediatric patients were less likely to receive NOM (OR: 0.45) compared to White, non-Hispanic patients.
- Black patients experienced a longer hospital stay by 0.6 days (P=0.010).
- Uninsured patients showed a trend towards less NOM (OR: 0.52), and publicly insured patients had a longer stay (0.24 days).
Conclusions:
- Disparities in NOM utilization and length of stay were observed for Black and uninsured pediatric BSI patients.
- These findings extend the understanding of racial and socioeconomic disparities in trauma care to pediatric populations.
- Further research is needed to identify the root causes of these identified disparities in pediatric BSI management.
Introduction:
Racial and ethnic disparities in the management of adult patients with blunt splenic injuries (BSIs) have been previously demonstrated. It is unknown if similar disparities exist in pediatric patients with BSIs. Management of BSIs can include operative management, but nonoperative management (NOM) is preferred. This study assesses the association of race and insurance status on use of NOM among pediatric (aged < 18 y) patients following BSI.
Materials And Methods:
Data were abstracted from the American College of Surgeons Trauma Quality Improvement Program Participant Use Files for calendar years 2013-2017. Multivariate logistic regression was used to evaluate the associations between race or insurance status and NOM while controlling for injury severity, age, and facility type. Secondary outcomes included blood transfusion within 24 h and hospital length of stay.
Results:
We analyzed 1436 pediatric BSI patients. Black, non-Hispanic patients were less likely (odds ratio: 0.45, 95% confidence interval: 0.21-1.02, P = 0.043) to undergo NOM and stayed 0.6 d longer (P = 0.010) than White, non-Hispanic patients. Uninsured patients were less likely (odds ratio: 0.52, 95% CI: 0.25-1.11, P = 0.080) to undergo NOM and publicly insured patients stayed 0.24 d (P = 0.048) longer than privately insured patients.
Conclusions:
We found disparities in use of NOM for Black patients and uninsured patients as well as differences in length of stay. These results extend the literature on racial and socioeconomic disparities in care of trauma patients to pediatric BSI patients. Addressing these disparities requires additional studies aimed at identifying the underlying causes.
Related Concept Videos
01:26Flail Chest-II
Assessment:
1. Clinical Evaluation:
History:
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
01:28Esophageal Varices-II: Clinical Features and Management
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol...
01:27Fractures: Bone Repair
Minor fractures with no bone displacement are treated by immobilizing the fractured bone using a cast or splint. However, in the case of fractures with displaced bones, the broken bones are repositioned before immobilization to ensure successful healing without deformation and loss of function. The realignment of fractured bone ends is performed through a process called reduction. If the...
01:22Burn Injuries
The damage results in the death of skin cells, which can lead to a massive loss of fluid. Dehydration, electrolyte imbalance, and renal and circulatory failure follow, which can be fatal. Burn patients are treated with intravenous fluids to offset...