Trauma center variation in the management of pediatric patients with blunt abdominal solid organ injury: A national trauma data bank analysis

Arash Safavi, Erik D. Skarsgard, Peter Rhee, Bardiya Zangbar, Narong Kulvatunyou, Andrew Tang, Terence OKeeffe, Randall S. Friese, Bellal Joseph

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Background Nonoperative management of hemodynamically stable children with Solid Organ Injury (SOI) has become standard of care. The aim of this study is to identify differences in management of children with SOI treated at Adult Trauma Centers (ATC) versus Pediatric Trauma Centers (PTC). We hypothesized that patients treated at ATC would undergo more procedures than PTC. Methods Patients younger than 18 years old with isolated SOI (spleen, liver, kidney) who were treated at level I-II ATC or PTC were identified from the 2011-2012 National Trauma Data Bank. The primary outcome measure was the incidence of operative management. Data was analyzed using multivariate logistic regression analysis. Procedures were defined as surgery or transarterial embolization (TAE). Results 6799 children with SOI (spleen: 2375, liver: 2867, kidney: 1557) were included. Spleen surgery was performed more frequently at ATC than PTC {101 (7.7%) vs. 52 (4.9%); P=0.007}. After adjusting for potential confounders (grade of injury, age, gender and injury severity score), admission at ATC was associated with higher odds of splenic surgery (OR: 1.5, 95% CI: 1.02-2.25; p=0.03). 11 and 8 children underwent kidney and liver operations respectively. TAE was performed in 17 patients with splenic, 34 with liver and 14 with kidney trauma. There was no practice variation between ATC and PTC regarding kidney and liver operations or TAE incidence. Conclusions Operative management for SOI was more often performed at ATC. The presence of significant disparity in the management of children with splenic injuries justifies efforts to use these surgeries as a reported national quality indicator for trauma programs.

Original languageEnglish (US)
Pages (from-to)499-502
Number of pages4
JournalJournal of Pediatric Surgery
Volume51
Issue number3
DOIs
StatePublished - Mar 1 2016
Externally publishedYes

Fingerprint

Trauma Centers
Databases
Pediatrics
Wounds and Injuries
Kidney
Liver
Spleen
Injury Severity Score
Incidence
Standard of Care
Logistic Models
Regression Analysis
Outcome Assessment (Health Care)

Keywords

  • Kidney
  • Liver
  • Pediatric trauma
  • Spleen

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery

Cite this

Trauma center variation in the management of pediatric patients with blunt abdominal solid organ injury : A national trauma data bank analysis. / Safavi, Arash; Skarsgard, Erik D.; Rhee, Peter; Zangbar, Bardiya; Kulvatunyou, Narong; Tang, Andrew; OKeeffe, Terence; Friese, Randall S.; Joseph, Bellal.

In: Journal of Pediatric Surgery, Vol. 51, No. 3, 01.03.2016, p. 499-502.

Research output: Contribution to journalArticle

Safavi, Arash ; Skarsgard, Erik D. ; Rhee, Peter ; Zangbar, Bardiya ; Kulvatunyou, Narong ; Tang, Andrew ; OKeeffe, Terence ; Friese, Randall S. ; Joseph, Bellal. / Trauma center variation in the management of pediatric patients with blunt abdominal solid organ injury : A national trauma data bank analysis. In: Journal of Pediatric Surgery. 2016 ; Vol. 51, No. 3. pp. 499-502.
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abstract = "Background Nonoperative management of hemodynamically stable children with Solid Organ Injury (SOI) has become standard of care. The aim of this study is to identify differences in management of children with SOI treated at Adult Trauma Centers (ATC) versus Pediatric Trauma Centers (PTC). We hypothesized that patients treated at ATC would undergo more procedures than PTC. Methods Patients younger than 18 years old with isolated SOI (spleen, liver, kidney) who were treated at level I-II ATC or PTC were identified from the 2011-2012 National Trauma Data Bank. The primary outcome measure was the incidence of operative management. Data was analyzed using multivariate logistic regression analysis. Procedures were defined as surgery or transarterial embolization (TAE). Results 6799 children with SOI (spleen: 2375, liver: 2867, kidney: 1557) were included. Spleen surgery was performed more frequently at ATC than PTC {101 (7.7{\%}) vs. 52 (4.9{\%}); P=0.007}. After adjusting for potential confounders (grade of injury, age, gender and injury severity score), admission at ATC was associated with higher odds of splenic surgery (OR: 1.5, 95{\%} CI: 1.02-2.25; p=0.03). 11 and 8 children underwent kidney and liver operations respectively. TAE was performed in 17 patients with splenic, 34 with liver and 14 with kidney trauma. There was no practice variation between ATC and PTC regarding kidney and liver operations or TAE incidence. Conclusions Operative management for SOI was more often performed at ATC. The presence of significant disparity in the management of children with splenic injuries justifies efforts to use these surgeries as a reported national quality indicator for trauma programs.",
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T1 - Trauma center variation in the management of pediatric patients with blunt abdominal solid organ injury

T2 - A national trauma data bank analysis

AU - Safavi, Arash

AU - Skarsgard, Erik D.

AU - Rhee, Peter

AU - Zangbar, Bardiya

AU - Kulvatunyou, Narong

AU - Tang, Andrew

AU - OKeeffe, Terence

AU - Friese, Randall S.

AU - Joseph, Bellal

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N2 - Background Nonoperative management of hemodynamically stable children with Solid Organ Injury (SOI) has become standard of care. The aim of this study is to identify differences in management of children with SOI treated at Adult Trauma Centers (ATC) versus Pediatric Trauma Centers (PTC). We hypothesized that patients treated at ATC would undergo more procedures than PTC. Methods Patients younger than 18 years old with isolated SOI (spleen, liver, kidney) who were treated at level I-II ATC or PTC were identified from the 2011-2012 National Trauma Data Bank. The primary outcome measure was the incidence of operative management. Data was analyzed using multivariate logistic regression analysis. Procedures were defined as surgery or transarterial embolization (TAE). Results 6799 children with SOI (spleen: 2375, liver: 2867, kidney: 1557) were included. Spleen surgery was performed more frequently at ATC than PTC {101 (7.7%) vs. 52 (4.9%); P=0.007}. After adjusting for potential confounders (grade of injury, age, gender and injury severity score), admission at ATC was associated with higher odds of splenic surgery (OR: 1.5, 95% CI: 1.02-2.25; p=0.03). 11 and 8 children underwent kidney and liver operations respectively. TAE was performed in 17 patients with splenic, 34 with liver and 14 with kidney trauma. There was no practice variation between ATC and PTC regarding kidney and liver operations or TAE incidence. Conclusions Operative management for SOI was more often performed at ATC. The presence of significant disparity in the management of children with splenic injuries justifies efforts to use these surgeries as a reported national quality indicator for trauma programs.

AB - Background Nonoperative management of hemodynamically stable children with Solid Organ Injury (SOI) has become standard of care. The aim of this study is to identify differences in management of children with SOI treated at Adult Trauma Centers (ATC) versus Pediatric Trauma Centers (PTC). We hypothesized that patients treated at ATC would undergo more procedures than PTC. Methods Patients younger than 18 years old with isolated SOI (spleen, liver, kidney) who were treated at level I-II ATC or PTC were identified from the 2011-2012 National Trauma Data Bank. The primary outcome measure was the incidence of operative management. Data was analyzed using multivariate logistic regression analysis. Procedures were defined as surgery or transarterial embolization (TAE). Results 6799 children with SOI (spleen: 2375, liver: 2867, kidney: 1557) were included. Spleen surgery was performed more frequently at ATC than PTC {101 (7.7%) vs. 52 (4.9%); P=0.007}. After adjusting for potential confounders (grade of injury, age, gender and injury severity score), admission at ATC was associated with higher odds of splenic surgery (OR: 1.5, 95% CI: 1.02-2.25; p=0.03). 11 and 8 children underwent kidney and liver operations respectively. TAE was performed in 17 patients with splenic, 34 with liver and 14 with kidney trauma. There was no practice variation between ATC and PTC regarding kidney and liver operations or TAE incidence. Conclusions Operative management for SOI was more often performed at ATC. The presence of significant disparity in the management of children with splenic injuries justifies efforts to use these surgeries as a reported national quality indicator for trauma programs.

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