Association between pediatric blunt splenic injury volume and the splenectomy rate

Abstract

Background/purposeWhile pediatric trauma centers are shown to have lower splenectomy rate as compared to adult trauma centers, it remains unknown whether other institutional factors such as case volumes would have an impact on the splenectomy rate in pediatric blunt splenic injury (BSI). MethodsPediatric patients who sustained BSI were identified from the National Trauma Data Bank 2007–2014. A hierarchical logistic regression model was built to evaluate differences in risk-adjusted splenectomy rate and in-hospital mortality in between trauma centers with different pediatric BSI case volumes. ResultsA total of 7621 children who met criteria were treated at trauma centers with different pediatric BSI case volumes (0–60, 61–120, 121–180, 181–240 cases during 2007–2014 for Group 1, 2, 3, and 4, respectively). High volume centers were shown to have decreased splenectomy rates (odds ratios [OR] 0.50 and 0.64, 95% confidence intervals [CI] 0.30–0.83, 0.44–0.95 for Groups 3 and 4, respectively) with an additional survival benefit in Group 4 (OR 0.452, 95%CI 0.257–0.793) when compared to the lowest volume centers (Group 1). ConclusionsHigher pediatric BSI case volume was associated with lower splenectomy rate with an additional survival benefit. Trauma centers' volume in pediatric BSI may be an important factor for the improved splenic preservation. Level of evidenceRetrospective comparative study, Level III.