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Disparities In Isolated, Serious, Blunt Splenic Injury Outcomes For Pediatric Patients
Whitney Orji, Robert Swendiman, Nicolas Muñoz, Myron Allukian, III, *Gary Nace, *Michael Nance
University of Pennsylvania, Philadelphia, PA

Background: Healthcare disparities are pervasive in medicine and surgery.1,2 We aimed to characterize disparities that may exist in the care of pediatric patients with blunt splenic injuries.
Methods:
The Trauma Quality Improvement Program data set (2016-2018) was queried for patients ≤18 years who sustained a serious, blunt splenic injury (AIS ≥3) with no other serious injury (AIS >2). Patient demographics, injury characteristics, and outcomes were summarized, and multivariable logistic regression was used to determine their association with splenectomy, angiography, and a combined intervention outcome.
Findings:
From 2016-2018, 2,253 children were treated for an isolated blunt splenic injury at a high-level trauma center (Level I or II). The cohort was predominantly white (79.7%) and privately insured (62.3%). The median injury severity score (ISS) was 14 (IQR 9-17). Less than 2% of patients underwent angiography and 6% underwent splenectomy. Increasing age, injury severity, and length of stay conferred greater odds of intervention. Neither race, ethnicity, nor insurance type were significantly associated with odds of intervention. Treatment at a pediatric or combined trauma center was associated with lower odds of intervention.
Conclusions:
In this cohort of patients with a common pediatric injury, there was no racial or insurance-based disparity in rates of intervention. This may be due in part to the protocolized nature of care for splenic injuries. Future work should account for the cohort’s relative homogeneity.

Odds of splenectomy, angiography, or both (* p-value < 0.05)
Odds of splenectomyOdds of angiographyOdds of either interventionOdds of either intervention
Age1.167 [1.09,1.25]*1.100 [0.99,1.23]1.151 [1.09,1.22]*1.151 [1.09,1.22]*
Race (Black v white)0.586 [0.20,1.73]0.548 [0.07,4.18]0.529 [0.20,1.41]0.529 [0.20,1.41]
Ethnicity (Hispanic/Latino v not)1.213 [0.65,2.25]2.442 [0.91,6.58]1.351 [0.76,2.39]1.351 [0.76,2.39]
Payer (private v public)0.757 [0.47,1.22]1.641 [0.64,4.23]0.926 [0.60,1.44]0.926 [0.60,1.44]
Trauma center type (pediatric v adult)0.112 [0.04,0.32]*0.483 [0.15,1.53]0.158 [0.07,0.34]*0.158 [0.07,0.34]*


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