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

Area of Science:

• Pediatric Surgery
• Trauma Management
• Surgical Outcomes

Background:

• Non-operative management is standard for pediatric blunt splenic injuries, but consensus on failure criteria and management strategies is lacking.
• Variability in treatment approaches exists across different pediatric trauma centers.
• This study investigates whether pediatric surgical fellowship programs influence the management of blunt splenic injuries.

Purpose of the Study:

• To determine if pediatric trauma centers with fellowship programs have different rates of surgical intervention for blunt splenic injuries compared to centers without fellowship programs.
• To analyze the impact of fellowship training on the success of non-operative management for pediatric blunt splenic injuries.

Main Methods:

• The Pediatric Health Information System (PHIS) database was queried for pediatric patients (≤15 years) with splenic injuries from 2016-2024, excluding penetrating trauma.
• Injury Severity Score (ISS) was estimated using ICD-10 codes.
• The primary outcome was splenic surgery or embolization, identified via ICD-10-PCS codes.

Main Results:

• Out of 6,853 patients with blunt splenic injury, 4.7% underwent surgical or endovascular intervention.
• Hospitals with pediatric surgical fellowship programs demonstrated significantly lower intervention rates (4.2% vs. 6.3%, p<0.01).
• Multivariable analysis confirmed that patients with severe injuries at fellowship-affiliated hospitals were less likely to undergo splenectomy (OR 0.37) or embolization (OR 0.45), even after controlling for confounders.

Conclusions:

• Pediatric surgical fellowship training is associated with a higher success rate in non-operative management of blunt splenic injuries.
• Institutions with fellowship programs show less variability and are more likely to successfully manage blunt splenic injuries non-operatively.
• These findings suggest fellowship training plays a role in optimizing treatment strategies for pediatric blunt splenic injuries.