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Less is more: management of pediatric splenic injury.

OBJECTIVE
To analyze national trends in the nonoperative management of pediatric splenic injury.


DESIGN
Retrospective cohort analysis.


PATIENTS
All children and adolescents 18 years or younger from 2 national databases who were hospitalized with pediatric splenic injury.


SETTING
Data from 9 years of the National Inpatient Sample database (2000-2008) and 3 years of Kids' Inpatient Database (2000, 2003, and 2006).


MAIN OUTCOME MEASURES
We calculated and chronicled rates of splenectomy, angiography, and transfusion from 2000 to 2008.


RESULTS
During the study period, the rate of splenectomy decreased from 18.25% to 10.86%. Changes in nonoperative management included more than a 2-fold increase in angiography, from 2.43% to 6.94%, and a significant increase in transfusion, from 7.71% to 11.49%. Operative management was associated with increased length of stay (9.15 vs 6.52 days) and higher mean total hospital charges ($74 981.26 vs $36 156.30). Cases occurring in rural locations were more likely to undergo operative management (odds ratio, 1.24 [95% CI, 1.18-1.31]; P < .001), but less likely to undergo angiography (0.82 [0.76-0.89]; P < .001).


CONCLUSIONS
Children with pediatric splenic injury are undergoing fewer splenectomies but more angiography. Rural location may be an independent risk factor for operative management. Further studies are needed to assess for disparity in access to and availability of aggressive nonoperative management.