Disparity in Management and Long-term Outcomes of Pediatric Splenic Injury in California
| Autor: | Henry G. Cryer, Stephen B. Shew, Howard C. Jen, Areti Tillou |
|---|---|
| Rok vydání: | 2010 |
| Předmět: |
Male
medicine.medical_specialty Adolescent Poison control Wounds Nonpenetrating Patient Readmission Suicide prevention California Occupational safety and health Postoperative Complications fluids and secretions parasitic diseases Injury prevention Long term outcomes Humans Medicine Nonoperative management Child Intensive care medicine business.industry Background data Infant Human factors and ergonomics medicine.disease Treatment Outcome Child Preschool Practice Guidelines as Topic Female Surgery Medical emergency business Intestinal Obstruction Spleen |
| Zdroj: | Annals of Surgery. 251:1162-1166 |
| ISSN: | 0003-4932 |
| DOI: | 10.1097/sla.0b013e3181c98271 |
| Popis: | To determine the impact of evidence-based guidelines on the disparities in management of pediatric splenic injuries (PSI).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.From 1999 to 2006, childrenor = 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.The overall rates of immediate operative management (IOM) decreased significantly from 23% in 1999 to 15% in 2006 (P0.001). This decline was attributed entirely to reduction of IOM at non-children's hospitals (NCH) (29% to 20%, P0.001). 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.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. |
| Databáze: | OpenAIRE |
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