Variation in Management of Blunt Splenic Injury by Trauma Center Training Status

Pediatric trauma surgeons have been the vanguard of nonoperative management of blunt splenic injuries. However, there is no uniform consensus on the determination of failure of nonoperative management and variability exists in management strategies across institutions. We hypothesized that centers with pediatric surgical fellowships would be less likely to pursue surgical management of blunt splenic injuries than other trauma centers without fellowship programs.

The Pediatric Health Information System was queried for all patients 15 years old or younger admitted with splenic injuries between 2016 and 2024. Penetrating injuries were excluded. ICD-10 diagnostic codes were used to estimate the Injury Severity Score. The primary outcome was splenic surgery or embolization, identified by ICD-10-Procedure Coding System code.

There were 6,853 patients identified with blunt splenic injury, of whom 319 (4.7%) underwent either splenic surgical intervention or percutaneous endovascular embolization. There was significant variability in splenic intervention rates among institutions, with fellowshiptraining hospitals having significantly lower rates of intervention (4.2% vs 6.3%, p < 0.01). Multivariable logistic regression, controlling for patient demographics, injury severity, and hospital characteristics, demonstrated that patients with severe splenic injuries treated at hospitals with a fellowship were less likely to undergo splenectomy (odds ratio 0.37, 95% CI 0.20 to 0.66, p < 0.01) or endovascular intervention (odds ratio 0.45, 95% CI 0.22 to 0.91, p = 0.03).

In the setting of significant interinstitutional variability in the management of pediatric blunt splenic injury, institutions with pediatric surgical fellowship training programs are more likely to successfully pursue nonoperative management, even after controlling for injury severity and patient demographics.