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Variation in Management of Splenic Injuries Among Pediatric Hospitals
Chinwendu Onwubiko, MD, Mary A. Arbuthnot Thorpe, DO, Michelle Osborne, MPH, and David Mooney, MD, MPH, Boston's Children's Hospital, Harvard Medical School, Boston MA

Abstract:
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 Database was queried for patients ?18 years admitted with a splenic injury from 2004-2013, and fields extracted were age, gender, intensive care unit (ICU) admission, procedures performed, length of stay, mortality, and readmission. Results: Between 2004-2013, 9681 children admitted with splenic injuries were identified. Per hospital volume ranged from 8-580 patients over the 10-year period (whole group mean 210.4). Mean age was 10.3 years and 71% of patients were boys. For patients with a splenic grade reported, the whole group mean was 2.7 (hospital mean range from 2-4). Children admitted to the ICU ranged from 0-73.4% (mean 37.8%). Overall mean length of stay was 6.1 days, but ranged from 3.4-11.6 days. The operative rate ranged from 0 to 12.5%; 2 hospitals (4.3%) did not perform a splenic operation during the study period. The mortality rate was zero for 7 hospitals and ranged from 0.9 to 5.9% for the remainder. Readmission rate also varied from 0 to 57.6% (whole group mean 18.5%). Conclusion: These data highlight the presence of variation in splenic injury management among pediatric facilities, despite widespread dissemination of practice standards.
Objective:
Recognize variation in management of splenic injuries.
Objective Content: Though there are established practice guidelines for splenic injury management in pediatric trauma, there is still variation even within children's hospitals.


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