Variation in the management of adolescent patients with blunt abdominal solid organ injury between adult versus pediatric trauma centers: an analysis of a statewide trauma database

• Published in: The Journal of surgical research 2013-08, Vol.183 (2), p.808-813
• Main Authors: Matsushima, Kazuhide, MD, Kulaylat, Afif N., MD, Won, Eugene J., BA, Stokes, Audrey L., BA, Schaefer, Eric W., MS, Frankel, Heidi L., MD
• Format: Article
• Language: English
• Subjects: Abdominal Injuries - epidemiology; Abdominal Injuries - surgery; Adolescent; Adolescent trauma; Adult trauma center; Blunt abdominal solid organ injury; Databases, Factual - statistics & numerical data; Disease Management; Female; Humans; Incidence; Kidney - injuries; Kidney - surgery; Liver - injuries; Liver - surgery; Male; Pediatric trauma center; Pennsylvania - epidemiology; Retrospective Studies; Spleen - injuries; Spleen - surgery; Surgery; Trauma Centers - classification; Trauma Centers - statistics & numerical data; Wounds, Nonpenetrating - epidemiology; Wounds, Nonpenetrating - surgery
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2013.02.050

Abstract Background Optimal management of adolescent trauma patients with blunt abdominal solid organ injury (SOI) remains controversial. The purpose of this study was to identify management differences in adolescents with SOI treated at adult trauma centers (ATC) versus pediatric trauma centers (PTC). We hypothesized that adolescents with SOI would undergo different treatment at ATC and PTC. Materials and methods Retrospective review of the Pennsylvania Trauma Systems Foundation database from 2005–2010 was performed. Adolescent patients (13–18 y old) with SOI (spleen, liver, and kidney injury) were included. Patient baseline characteristics and care processes for each injury were compared between ATC and PTC. Results A total of 1532 patients with at least one SOI were identified: 946 patients had a splenic injury, 505 had a liver injury, and 424 had a kidney injury. Spleen and liver procedures were performed more often at ATC than at PTC irrespective of injury grade (respectively, 16.1% versus 3.2%, 5.9% versus 0%; P < 0.01). Transarterial embolization for splenic injury was more frequently performed at ATC (2.8% versus 0.6%; P = 0.02). After adjusting for potential confounding factors, care at PTC was significantly associated with lower odds of splenic procedure for patients with splenic injury (OR: 0.16, 95% CI: 0.08–0.36, P < 0.001). In a subgroup analysis of nontransfer patients, care at PTC remained significantly associated with lower odds of splenic procedure (OR: 0.24, 95% CI: 0.10–0.59, P  = 0.002) despite higher median injury severity score than ATC. Conclusions Significant differences in the management of adolescents with SOI were identified in Pennsylvania. Operative intervention for SOI was more often performed at ATC than at PTC. Further study will be needed to address the impact of these disparities on patient outcomes.