Trends in pediatric spleen management: Do hospital type and ownership still matter?
Nonoperative management of traumatic blunt splenic injury is preferred over splenectomy because of improved outcomes and reduced complications. However, variability in treatment is previously reported with respect to hospital profit types and ownership. Our study objectives were to investigate the p...
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| Veröffentlicht in: | The journal of trauma and acute care surgery 2015-05, Vol.78 (5), p.935-942 |
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| container_title | The journal of trauma and acute care surgery |
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| creator | Liu, Shaoming Bowman, Stephen M Smith, Tyler C Sharar, Sam R |
| description | Nonoperative management of traumatic blunt splenic injury is preferred over splenectomy because of improved outcomes and reduced complications. However, variability in treatment is previously reported with respect to hospital profit types and ownership.
Our study objectives were to investigate the past decade's trends in pediatric splenic injury management and to determine whether previously reported disparities by hospital type have changed. We analyzed data from the Kid's Inpatient Database from Healthcare Cost and Utility Project for Years 2000, 2003, 2006, and 2009. Multivariable logistic regression was used to investigate the likelihood of receiving splenectomy in different hospital profit and ownership types. Patients 18 years and younger admitted with blunt splenic injury (DRG International Classification of Diseases-9th Rev.-Clinical Modification code 865) were included. Treatment was dichotomized into nonoperative management, defined as initial attempt at nonoperative management, and operative management, defined as splenectomy within 1 day of admission.
Of 17,044 patient records, 11,893 participants were studied. Not-for-profit hospitals demonstrated a higher rate of nonoperative management than for-profit hospitals in 2000 (83.8% vs. 71.0 %). Both not-for-profit and for-profit hospitals increased the use of nonoperative management, with a narrower disparity observed by 2009 (87.5% vs. 84.6%). The use of splenectomy was reduced significantly between 2000 and 2003 (odds ratio, 0.66; weighted 95% confidence interval, 0.54-0.81). The rate of nonoperative management in children's hospitals remained very high across the study period (98.6% in 2009) and continued to be the benchmark for pediatric spleen injury management.
Improvement was observed in nonoperative management rates for pediatric spleen injuries in both not-for-profit and for-profit hospitals. However, general hospitals still fail to reach the target of 90% nonoperative management. Further investigations are needed to facilitate optimal management of such children in general hospitals.
Epidemiologic and prognostic study, level III. |
| doi_str_mv | 10.1097/TA.0000000000000621 |
| format | Article |
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Our study objectives were to investigate the past decade's trends in pediatric splenic injury management and to determine whether previously reported disparities by hospital type have changed. We analyzed data from the Kid's Inpatient Database from Healthcare Cost and Utility Project for Years 2000, 2003, 2006, and 2009. Multivariable logistic regression was used to investigate the likelihood of receiving splenectomy in different hospital profit and ownership types. Patients 18 years and younger admitted with blunt splenic injury (DRG International Classification of Diseases-9th Rev.-Clinical Modification code 865) were included. Treatment was dichotomized into nonoperative management, defined as initial attempt at nonoperative management, and operative management, defined as splenectomy within 1 day of admission.
Of 17,044 patient records, 11,893 participants were studied. Not-for-profit hospitals demonstrated a higher rate of nonoperative management than for-profit hospitals in 2000 (83.8% vs. 71.0 %). Both not-for-profit and for-profit hospitals increased the use of nonoperative management, with a narrower disparity observed by 2009 (87.5% vs. 84.6%). The use of splenectomy was reduced significantly between 2000 and 2003 (odds ratio, 0.66; weighted 95% confidence interval, 0.54-0.81). The rate of nonoperative management in children's hospitals remained very high across the study period (98.6% in 2009) and continued to be the benchmark for pediatric spleen injury management.
Improvement was observed in nonoperative management rates for pediatric spleen injuries in both not-for-profit and for-profit hospitals. However, general hospitals still fail to reach the target of 90% nonoperative management. Further investigations are needed to facilitate optimal management of such children in general hospitals.
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Our study objectives were to investigate the past decade's trends in pediatric splenic injury management and to determine whether previously reported disparities by hospital type have changed. We analyzed data from the Kid's Inpatient Database from Healthcare Cost and Utility Project for Years 2000, 2003, 2006, and 2009. Multivariable logistic regression was used to investigate the likelihood of receiving splenectomy in different hospital profit and ownership types. Patients 18 years and younger admitted with blunt splenic injury (DRG International Classification of Diseases-9th Rev.-Clinical Modification code 865) were included. Treatment was dichotomized into nonoperative management, defined as initial attempt at nonoperative management, and operative management, defined as splenectomy within 1 day of admission.
Of 17,044 patient records, 11,893 participants were studied. Not-for-profit hospitals demonstrated a higher rate of nonoperative management than for-profit hospitals in 2000 (83.8% vs. 71.0 %). Both not-for-profit and for-profit hospitals increased the use of nonoperative management, with a narrower disparity observed by 2009 (87.5% vs. 84.6%). The use of splenectomy was reduced significantly between 2000 and 2003 (odds ratio, 0.66; weighted 95% confidence interval, 0.54-0.81). The rate of nonoperative management in children's hospitals remained very high across the study period (98.6% in 2009) and continued to be the benchmark for pediatric spleen injury management.
Improvement was observed in nonoperative management rates for pediatric spleen injuries in both not-for-profit and for-profit hospitals. However, general hospitals still fail to reach the target of 90% nonoperative management. Further investigations are needed to facilitate optimal management of such children in general hospitals.
Epidemiologic and prognostic study, level III.</description><subject>Abdominal Injuries - diagnosis</subject><subject>Abdominal Injuries - epidemiology</subject><subject>Abdominal Injuries - therapy</subject><subject>Adolescent</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Disease Management</subject><subject>Female</subject><subject>Hospitals, Pediatric - organization & administration</subject><subject>Humans</subject><subject>Incidence</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Injury Severity Score</subject><subject>Male</subject><subject>Ownership</subject><subject>Retrospective Studies</subject><subject>Spleen - injuries</subject><subject>Splenectomy - trends</subject><subject>Trauma Centers - organization & administration</subject><subject>United States - epidemiology</subject><subject>Wounds, Nonpenetrating - diagnosis</subject><subject>Wounds, Nonpenetrating - epidemiology</subject><subject>Wounds, Nonpenetrating - therapy</subject><issn>2163-0755</issn><issn>2163-0763</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkE1Lw0AQhhdRbKn9BYLs0UvqfmSziRcJ9RMKHoznsMlO7EqyibtbpP_elNYizuWdw_POwIPQJSULSjJ5U-QL8ncSRk_QlNGER0Qm_PS4CzFBc-8_d5BIMi7EOZowkZEspmyK3goHVntsLB5AGxWcqbEfWgCLO2XVB3Rgwy2-7_G694MJqsVhOwBWVuP-24LzazNgH0zbjoUQwN1doLNGtR7mh5yh98eHYvkcrV6fXpb5KqqZECHSqlIUKK1SzqimnMlUC5E2SQUMmI6zplENyXQFWiUihUpJKRWppJYaaqj5DF3v7w6u_9qAD2VnfA1tqyz0G1_SZDQRkzijI8r3aO167x005eBMp9y2pKTcCS2LvPwvdGxdHR5sqg70sfOrj_8Ay01xsw</recordid><startdate>20150501</startdate><enddate>20150501</enddate><creator>Liu, Shaoming</creator><creator>Bowman, Stephen M</creator><creator>Smith, Tyler C</creator><creator>Sharar, Sam R</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20150501</creationdate><title>Trends in pediatric spleen management: Do hospital type and ownership still matter?</title><author>Liu, Shaoming ; Bowman, Stephen M ; Smith, Tyler C ; Sharar, Sam R</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c255t-daba1e11b8321d13278d558f6be2e2d49ffaf09dbeda658eba777a0b7d7decec3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Abdominal Injuries - diagnosis</topic><topic>Abdominal Injuries - epidemiology</topic><topic>Abdominal Injuries - therapy</topic><topic>Adolescent</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Disease Management</topic><topic>Female</topic><topic>Hospitals, Pediatric - organization & administration</topic><topic>Humans</topic><topic>Incidence</topic><topic>Infant</topic><topic>Infant, Newborn</topic><topic>Injury Severity Score</topic><topic>Male</topic><topic>Ownership</topic><topic>Retrospective Studies</topic><topic>Spleen - injuries</topic><topic>Splenectomy - trends</topic><topic>Trauma Centers - organization & administration</topic><topic>United States - epidemiology</topic><topic>Wounds, Nonpenetrating - diagnosis</topic><topic>Wounds, Nonpenetrating - epidemiology</topic><topic>Wounds, Nonpenetrating - therapy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Liu, Shaoming</creatorcontrib><creatorcontrib>Bowman, Stephen M</creatorcontrib><creatorcontrib>Smith, Tyler C</creatorcontrib><creatorcontrib>Sharar, Sam R</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The journal of trauma and acute care surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Liu, Shaoming</au><au>Bowman, Stephen M</au><au>Smith, Tyler C</au><au>Sharar, Sam R</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Trends in pediatric spleen management: Do hospital type and ownership still matter?</atitle><jtitle>The journal of trauma and acute care surgery</jtitle><addtitle>J Trauma Acute Care Surg</addtitle><date>2015-05-01</date><risdate>2015</risdate><volume>78</volume><issue>5</issue><spage>935</spage><epage>942</epage><pages>935-942</pages><issn>2163-0755</issn><eissn>2163-0763</eissn><abstract>Nonoperative management of traumatic blunt splenic injury is preferred over splenectomy because of improved outcomes and reduced complications. However, variability in treatment is previously reported with respect to hospital profit types and ownership.
Our study objectives were to investigate the past decade's trends in pediatric splenic injury management and to determine whether previously reported disparities by hospital type have changed. We analyzed data from the Kid's Inpatient Database from Healthcare Cost and Utility Project for Years 2000, 2003, 2006, and 2009. Multivariable logistic regression was used to investigate the likelihood of receiving splenectomy in different hospital profit and ownership types. Patients 18 years and younger admitted with blunt splenic injury (DRG International Classification of Diseases-9th Rev.-Clinical Modification code 865) were included. Treatment was dichotomized into nonoperative management, defined as initial attempt at nonoperative management, and operative management, defined as splenectomy within 1 day of admission.
Of 17,044 patient records, 11,893 participants were studied. Not-for-profit hospitals demonstrated a higher rate of nonoperative management than for-profit hospitals in 2000 (83.8% vs. 71.0 %). Both not-for-profit and for-profit hospitals increased the use of nonoperative management, with a narrower disparity observed by 2009 (87.5% vs. 84.6%). The use of splenectomy was reduced significantly between 2000 and 2003 (odds ratio, 0.66; weighted 95% confidence interval, 0.54-0.81). The rate of nonoperative management in children's hospitals remained very high across the study period (98.6% in 2009) and continued to be the benchmark for pediatric spleen injury management.
Improvement was observed in nonoperative management rates for pediatric spleen injuries in both not-for-profit and for-profit hospitals. However, general hospitals still fail to reach the target of 90% nonoperative management. Further investigations are needed to facilitate optimal management of such children in general hospitals.
Epidemiologic and prognostic study, level III.</abstract><cop>United States</cop><pmid>25909412</pmid><doi>10.1097/TA.0000000000000621</doi><tpages>8</tpages></addata></record> |
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| subjects | Abdominal Injuries - diagnosis Abdominal Injuries - epidemiology Abdominal Injuries - therapy Adolescent Child Child, Preschool Disease Management Female Hospitals, Pediatric - organization & administration Humans Incidence Infant Infant, Newborn Injury Severity Score Male Ownership Retrospective Studies Spleen - injuries Splenectomy - trends Trauma Centers - organization & administration United States - epidemiology Wounds, Nonpenetrating - diagnosis Wounds, Nonpenetrating - epidemiology Wounds, Nonpenetrating - therapy |
| title | Trends in pediatric spleen management: Do hospital type and ownership still matter? |
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