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Variation in the Management Of Splenic Injuries Among Children's Hospitals
Chinwendu Onwubiko, MD; Michelle Osbourne, MPH; David Mooney, MD, MPH
Boston Children's Hospital, Boston, MA

Background: Variation in the management of splenic injuries between adult and pediatric facilities has been reported. This study analyzes variation in management among pediatric facilities.

Methods: The Pediatric Health Information System for calendar 2013 was queried for patients under 18 years admitted to one of 44 reporting pediatric facilities and fields extracted were age, gender, ICU admission, procedures performed, mortality, and readmission. Correlation was determined using the Excel Analysis ToolPack (Microsoft).

Results: 808 children with splenic injuries were identified. Per hospital volume varied from 1-47 (mean 18.3). Mean age at admission was 10.4 years and 69% were boys. The percentage of children admitted to the intensive care unit (ICU) ranged from 0-83% (mean 36%). 11 children (1.3%) underwent splenectomy and 5 (.7%) underwent splenic repair. 34 of 44 hospitals (77%) did not perform a splenic operation, while the splenic operative rate of hospitals that did ranged from 2.3 to 18.75% (whole group mean 1.5%). The percent mortality was zero for 26 hospitals and ranged from 2.2 to 12.5% for the other hospitals (whole group mean 3.3%). Readmission rate also varied from 0 to 67% (whole group mean 14.8%). No correlation was found between hospital volume of splenic injuries and ICU admission (p=.0805), operative rate (p=.19) and readmission rate (p=.25).

Conclusion: Variation in the management of pediatric splenic injuries between adult and pediatric hospitals is known. These data highlight the presence of variation in the management of this common injury among pediatric facilities, despite widespread dissemination of practice standards.

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