Variation in the management of pediatric splenic injuries in New Hampshire

Variation in the management of pediatric splenic injuries in New Hampshire

Purpose: The aim of this study was to determine if variation in the management of pediatric splenic injuries occurs among hospitals in New Hampshire. Methods: Data accrued for each patient less than 18 years of age discharged from an acute care hospital in New Hampshire with a splenic injury diagnos...

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Bibliographic Details
Published in:Journal of pediatric surgery Vol. 33; no. 7; pp. 1076 - 1080
Main Authors: Mooney, David P, Birkmeyer, Nancy J.O, Udell, John V, Shorter, Nicholas A
Format: Journal Article
Language:English
Published: United States Elsevier Inc 1998
Subjects:
Abdominal Injuries - epidemiology
Abdominal Injuries - therapy
Adolescent
Analysis of Variance
Chi-Square Distribution
Child
Child, Preschool
Databases, Factual
Diagnosis-Related Groups
Female
Humans
Infant
Infant, Newborn
Injury Severity Score
Male
New Hampshire - epidemiology
Spleen - injuries
Spleen - surgery
Splenectomy - statistics & numerical data
Wounds, Nonpenetrating - epidemiology
Wounds, Nonpenetrating - therapy
New Hampshire
managment
Pediatric splenic injury
outcome
splenectomy
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Summary:Purpose: The aim of this study was to determine if variation in the management of pediatric splenic injuries occurs among hospitals in New Hampshire. Methods: Data accrued for each patient less than 18 years of age discharged from an acute care hospital in New Hampshire with a splenic injury diagnosis code or splenic procedure code were analyzed for the years 1991 through 1994. The splenectomy, splenorrhaphy, and nonoperative management rates of each hospital were analyzed and adjusted for case mix using direct standardization. Managment rates were determined for patients with isolated splenic injuries, which were then adjusted for case mix. Results: Variation in the management of pediatric splenic injuries was found to occur among hospitals in New Hampshire. Management variation persisted despite adjustment for case mix. Variation was also noted in the management of patients with isolated splenic injuries and persisted after case mix adjustment. Conclusion: Even after adjustment for case mix, if all children with splenic injuries in New Hampshire were treated in the same fashion as at the state's children's hospital, over 73% of splenectomies and 70% of splenorrhaphies performed for trauma may have been avoided.
ISSN:0022-3468
1531-5037
DOI:10.1016/S0022-3468(98)90534-6