MANAGEMENT OF PEDIATRIC BLUNT SPLENIC INJURY - COMPARISON OF PEDIATRIC AND ADULT TRAUMA SURGEONS

The majority of injured children requiring hospitalization in the Unit ed States are cared for by nonpediatric surgeons. To determine whether there are differences in the management strategies (frequency of oper ative intervention) of pediatric and nonpediatric surgeons caring for children with blunt splenic injury, the data for children with this in jury from the entire state of Vermont and the National Pediatric Traum a Registry were compared. From January 1, 1985 through December 31, 19 91, 817 children (aged <19 years) were entered into the study. There w as operative interven tion for splenic injury in 21% of the children m anaged by pediatric surgeons and in 52% of those managed by ''adult'' trauma surgeons (P < .05). This significance was maintained when opera tive rates were analyzed with control for injury severity score and ag e. The overall splenectomy rate was higher among cases treated by nonp ediatric surgeons (24% v 13%; P < .05). In addition, previously report ed 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 ho spital stay did not differ between the groups. Acute mortality rates w ere 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 surgeon s appear to manage children with blunt splenic injury with practice st andards more appropriate far adult patients. Outcome analysis must inc lude methods of care and their long- and short-term consequences to be considered valid. Copyright (C) 1995 by W.B. Saunders Company