Management of pediatric blunt splenic injury: Comparison of pediatric and adult trauma surgeons

Abstract

The majority of injured children requiring hospitalization in the United States are cared for by nonpediatric surgeons. To determine whether there are differences in the management strategies (frequency of operative intervention) of pediatric and nonpediatric surgeons caring for children with blunt splenic injury, the data for children with this injury from the entire state of Vermont and the National Pediatric Trauma Registry were compared. From January 1, 1985 through December 31, 1991, 817 children (aged <19 years) were entered into the study. There was operative intervention for splenic injury in 21% of the children managed by pediatric surgeons and in 52% of those managed by “adult” trauma surgeons ( P < .05). This significance was maintained when operative rates were analyzed with control for injury severity score and age. The overall splenectomy rate was higher among cases treated by nonpediatric surgeons (24% v 13%; P < .05). In addition, previously reported factors (transfusion requirements, length of stay, hospital costs) used by opponents to nonoperative management were studied to determine management influence. Both transfusion requirement and hospital cost were lower for patients managed nonoperatively ( P < .05). Length of hospital stay did not differ between the groups. Acute mortality rates were similar. The management of children with splenic injury must take into consideration the long-term morbidity associated with splenectomy as well as the acute operative morbidity. Today, adult trauma surgeons appear to manage children with blunt splenic injury with practice standards more appropriate for adult patients. Outcome analysis must include methods of care and their long- and short-term consequences to be considered valid.