Hospital characteristics associated with the management of pediatric splenic injuries |
| |
Authors: | Bowman Stephen M Zimmerman Frederick J Christakis Dimitri A Sharar Sam R Martin Diane P |
| |
Institution: | Department of Health Services (Mr Bowman and Drs Martin and Zimmerman), Child Health Institute (Drs Zimmerman and Christakis), Department of Anesthesiology (Dr Sharar), Department of Pediatrics (Dr Christakis), University of Washington, Seattle; and Office of EMS and Trauma, Washington State Department of Health, Olympia (Mr Bowman). |
| |
Abstract: | Context Despite evidence that more than 90% of children with traumatic injuries to the spleen can be successfully managed nonoperatively, there is significant variation in the use of splenectomy. As asplenic children are at increased risk of overwhelming postsplenectomy infection, nonoperative management may be considered a quality of care indicator. Objective To test the hypothesis that children are more likely to undergo splenectomy in general hospitals than in childrens hospitals. Design Retrospective cohort study using data from the Kids Inpatient Database (KID) for the year 2000. Multivariable regression was used to control for patient and hospital characteristics. Setting and Participants All children aged 0 to 16 years who were hospitalized with a traumatic (noniatrogenic) spleen injury in nonfederal short-stay hospitals in any of the 27 states participating in KID (N = 2851). Main Outcome Measure Splenectomy performed within 1 day of arrival. Results A total of 11 children (3%) with splenic injuries receiving care at childrens hospitals underwent splenectomy compared with 383 children (15.4%) cared for at general hospitals (P<.001). After adjusting for patient characteristics, injury severity, and hospital characteristics, splenectomy was more likely among children treated at general hospitals (odds ratio, 5.01; 95% confidence interval, 2.21-11.36) than among children treated at childrens hospitals. Conclusions There is considerable variation in the management of pediatric splenic injuries, with significantly lower rates of splenectomy at designated childrens hospitals. Quality improvement interventions, including increased education and training for physicians in general hospitals, may be needed to increase the use of spleen-conserving management practices. |
| |
Keywords: | |
本文献已被 PubMed 等数据库收录! |
| 点击此处可从《The Journal of the American Medical Association》浏览原始摘要信息 |
| 点击此处可从《The Journal of the American Medical Association》下载免费的PDF全文 |
|