Persistent disparities between trauma center types in the management of children with high-grade blunt splenic injuries.

Abstract

In the early 2000s, substantial variations were reported in the management of pediatric patients with blunt splenic injury (BSI). The purpose of this study was to assess the recent trends and disparities between different types of trauma centers. We hypothesized that there would be persistent disparities despite decreased trends in the rate of splenectomy. This is a retrospective cohort study using the American College of Surgeons Trauma Quality Improvement Program database. We included patients (age ≤18years) with high-grade BSI (Abbreviated Injury Scale 3-5) between 2014 and 2021. The patients were divided into three groups based on trauma center types (adult trauma centers [ATCs], mixed trauma centers [MTCs], and pediatric trauma centers [PTCs]). The primary outcome was the splenectomy rate. Logistic regression was performed to evaluate the association between trauma center types and clinical outcomes. Additionally, the trends in the rate of splenectomy at ATCs, MTCs, and PTCs were evaluated. A total of 6601 patients with high-grade BSI were included in the analysis. Overall splenectomy rates were 524 (17.5%), 448 (16.3%), and 32 (3.7%) in the ATC, MTC, and PTC groups, respectively. ATCs and MTCs had significantly higher splenectomy rates compared to PTCs (ATCs: OR=5.72, 95%CI=3.78-8.67, and p<0.001 and MTCs: OR=4.50, 95%CI=2.97-6.81, and p<0.001), while decreased trends in the splenectomy rates were observed in ATCs and MTCs (ATCs: OR=0.92, 95%CI=0.87-0.97, and p=0.003 and MTCs: OR=0.92, 95%CI=0.87-0.98, and p=0.013). This study suggested persistent disparities between different trauma center types in the management of children with high-grade BSI.