OBJECTIVE: To determine the impact of evidence-based guidelines on the disparities in management of pediatric splenic injuries (PSI). SUMMARY OF BACKGROUND DATA: Several studies have highlighted a disparity in the utilization of nonoperative management (NOM) for PSI based on hospital and surgeon characteristics. Whether evidence-based guidelines had an impact on mitigating this disparity is uncertain. METHODS: From 1999 to 2006, children < or = 18 years with PSI were extracted from California's Patient Discharge Database (n = 5089). Patient demographics, injury grade, immediate and delayed operations, readmissions, and complications were analyzed. RESULTS: The overall rates of immediate operative management (IOM) decreased significantly from 23% in 1999 to 15% in 2006 (P < 0.001). This decline was attributed entirely to reduction of IOM at non-children's hospitals (NCH) (29% to 20%, P < 0.001). In contrast, IOM rates were low and unchanged at children's hospital (CH) (9%, P = NS). Failed NOM (3.3%), readmissions for complications (0.6%), and operations (0.3%) were rare and unaffected by NOM increase. NCH had increased risk of IOM compared to CH in multivariate analysis (OR: 2.00, 99% CI: 1.09-3.57). The rate of delayed splenic rupture was 0.2%. There were no differences when comparing the rates of readmissions (1.0% vs. 0.4%, P = NS) and readmit operations (0.3% vs. 0.3%, P = NS) between IOM versus NOM. CONCLUSION: A steady increase in the utilization of NOM for PSI in California over time was attributed entirely to changing practices at NCH. Increasing NOM has occurred without a concurrent increase in complications. Delayed splenic ruptures were rare. Although IOM rates at NCH decreased over time, disparity in NOM utilization still exists between NCH and CH.
OBJECTIVE: To determine the impact of evidence-based guidelines on the disparities in management of pediatric splenic injuries (PSI). SUMMARY OF BACKGROUND DATA: Several studies have highlighted a disparity in the utilization of nonoperative management (NOM) for PSI based on hospital and surgeon characteristics. Whether evidence-based guidelines had an impact on mitigating this disparity is uncertain. METHODS: From 1999 to 2006, children < or = 18 years with PSI were extracted from California'sPatient Discharge Database (n = 5089). Patient demographics, injury grade, immediate and delayed operations, readmissions, and complications were analyzed. RESULTS: The overall rates of immediate operative management (IOM) decreased significantly from 23% in 1999 to 15% in 2006 (P < 0.001). This decline was attributed entirely to reduction of IOM at non-children's hospitals (NCH) (29% to 20%, P < 0.001). In contrast, IOM rates were low and unchanged at children's hospital (CH) (9%, P = NS). Failed NOM (3.3%), readmissions for complications (0.6%), and operations (0.3%) were rare and unaffected by NOM increase. NCH had increased risk of IOM compared to CH in multivariate analysis (OR: 2.00, 99% CI: 1.09-3.57). The rate of delayed splenic rupture was 0.2%. There were no differences when comparing the rates of readmissions (1.0% vs. 0.4%, P = NS) and readmit operations (0.3% vs. 0.3%, P = NS) between IOM versus NOM. CONCLUSION: A steady increase in the utilization of NOM for PSI in California over time was attributed entirely to changing practices at NCH. Increasing NOM has occurred without a concurrent increase in complications. Delayed splenic ruptures were rare. Although IOM rates at NCH decreased over time, disparity in NOM utilization still exists between NCH and CH.
Authors: Leslie A Dervan; Mary A King; Joseph Cuschieri; Frederick P Rivara; Noel S Weiss Journal: J Trauma Acute Care Surg Date: 2015-08 Impact factor: 3.313
Authors: Federico Coccolini; Giulia Montori; Fausto Catena; Yoram Kluger; Walter Biffl; Ernest E Moore; Viktor Reva; Camilla Bing; Miklosh Bala; Paola Fugazzola; Hany Bahouth; Ingo Marzi; George Velmahos; Rao Ivatury; Kjetil Soreide; Tal Horer; Richard Ten Broek; Bruno M Pereira; Gustavo P Fraga; Kenji Inaba; Joseph Kashuk; Neil Parry; Peter T Masiakos; Konstantinos S Mylonas; Andrew Kirkpatrick; Fikri Abu-Zidan; Carlos Augusto Gomes; Simone Vasilij Benatti; Noel Naidoo; Francesco Salvetti; Stefano Maccatrozzo; Vanni Agnoletti; Emiliano Gamberini; Leonardo Solaini; Antonio Costanzo; Andrea Celotti; Matteo Tomasoni; Vladimir Khokha; Catherine Arvieux; Lena Napolitano; Lauri Handolin; Michele Pisano; Stefano Magnone; David A Spain; Marc de Moya; Kimberly A Davis; Nicola De Angelis; Ari Leppaniemi; Paula Ferrada; Rifat Latifi; David Costa Navarro; Yashuiro Otomo; Raul Coimbra; Ronald V Maier; Frederick Moore; Sandro Rizoli; Boris Sakakushev; Joseph M Galante; Osvaldo Chiara; Stefania Cimbanassi; Alain Chichom Mefire; Dieter Weber; Marco Ceresoli; Andrew B Peitzman; Liban Wehlie; Massimo Sartelli; Salomone Di Saverio; Luca Ansaloni Journal: World J Emerg Surg Date: 2017-08-18 Impact factor: 5.469
Authors: Michel Teuben; Roy Spijkerman; Henrik Teuber; Roman Pfeifer; Hans-Christoph Pape; William Kramer; Luke Leenen Journal: Patient Saf Surg Date: 2020-01-03