Recorded presentation

David H. Rothstein, MD and David P. Mooney, MD. Surgery, Harvard University, Childrens Hospital Boston, 300 Longwood Ave, Boston, MA 02115, 617-355-2469, rothsd2000@yahoo.com

Purpose: To examine variation in the management of pediatric splenic injuries among hospitals in the United States and the risk factors for splenectomy.

Methods: Information on children less than 16 years of age with a splenic injury diagnosis code was extracted from an inpatient database of covering 68% of the nation’s population for the year 2000. Variables included: age, gender, race, injury diagnoses, splenic procedure code and calculated Injury Severity Score, as well as hospital pediatric status (freestanding, unit and adult), teaching status, annual trauma volume and national region. A multivariate logistic regression model was used to predict the risk of splenectomy based upon patient and hospital characteristics.

Results: 2,191 children with splenic injuries were identified. The crude rate of splenectomy varied significantly among pediatric hospital types: 3% at freestanding hospitals, 9% at unit hospitals and 15% at adult hospitals (p<0.001). Risk of splenectomy increased with the grade of splenic injury, patient age and the presence of multiple injuries. Despite adjustment for the above variables, children treated at an adult hospital had a 4.5 times increased risk, and those treated at a unit pediatric hospital a 2.9 times increased risk, of undergoing splenectomy than those cared for at a free-standing pediatric hospital (p<0.001 for each).

Conclusion: Children cared for at freestanding pediatric hospitals have a significantly lower risk of splenectomy than children treated at either adult hospitals or pediatric hospitals within an adult hospital. This may have implications for education, trauma triage and the establishment of practice guidelines.

Learning Objectives:

• Recognize the benefits of splenic preservation
• List different ways in which splenic trauma is treated
• Identify differences between splenic injury care provided by adult and pediatric hospitals

Keywords: Certificate of Need,

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Recorded presentation