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Practice patterns of pediatric surgeons caring for stable patients with traumatic solid organ injury
1Department of Surgery, University of Louisville, Kentucky, USA.
Insights
Nonoperative management of blunt solid organ injuries in children is often successful. A survey of pediatric surgeons suggests individualized care, with fewer resources potentially leading to equally effective, less expensive treatment protocols.
Area of Science:
- Pediatric Surgery
- Trauma Management
- Healthcare Economics
Background:
- Managed care pressures hospitals to reduce costs and length of stay.
- This financial climate may impact nonoperative management strategies for pediatric blunt solid organ injuries (spleen, liver, kidneys).
Purpose of the Study:
- To survey pediatric surgeons on current practices for nonoperative management of blunt solid organ injuries in children.
- To identify variations and consensus in management decisions.
Main Methods:
- A survey was distributed to pediatric surgeons at major children's hospitals in the United States.
- 87 out of 117 surveys (75% response rate) were analyzed.
Main Results:
- Nonoperative management failure rates are low in children with blunt solid organ injuries.
- Consensus exists on many management decisions (radiology, transfusion, activity).
- Significant variance in practice was observed for certain aspects of care.
Conclusions:
- Individualized surgical judgment is crucial, but low failure rates support nonoperative management guidelines.
- Resource utilization can be optimized, with less resource-intensive approaches proving effective.
- A recommended management protocol based on survey responses is proposed.
Background:
Managed care financing has resulted in pressure to decrease hospital days and lower per diem costs. This influence may ultimately affect nonoperative management of blunt solid organ injuries in children (spleen, liver, kidneys).
Methods:
Pediatric surgeons caring for trauma patients were surveyed regarding current practice patterns. One survey was sent to a representative staff pediatric surgeon at each major children's hospital or children's unit involved in the care of the injured child in the United States.
Results:
There were 87 responses to 117 surveys (75%). Relatively few children fail nonoperative management. For major management decisions, including radiographic study of choice; when to transfuse; and when to allow out of bed, home, and back to school, there was often a clear majority opinion of appropriate care. However, there was a wide variance in response for some questions.
Conclusions:
Surgical judgment must be individualized, but a low number of failures of nonoperative management is helpful in delineating safe practice guidelines. Surgeons using fewer resources than the norm may help delineate management schemes that are equally effective to more expensive care. Based on these responses a management protocol is recommended.