Variation in the management of pediatric splenic injuries in New Hampshire

Abstract Purpose: The aim of this study was to determine if variation in the management of pediatric splenic injuries occurs among hospitals in New Hampshire. Methods: Data accrued for each patient less than 18 years of age discharged from an acute care hospital in New Hampshire with a splenic injury diagnosis code or splenic procedure code were analyzed for the years 1991 through 1994. The splenectomy, splenorrhaphy, and nonoperative management rates of each hospital were analyzed and adjusted for case mix using direct standardization. Managment rates were determined for patients with isolated splenic injuries, which were then adjusted for case mix. Results: Variation in the management of pediatric splenic injuries was found to occur among hospitals in New Hampshire. Management variation persisted despite adjustment for case mix. Variation was also noted in the management of patients with isolated splenic injuries and persisted after case mix adjustment. Conclusion: Even after adjustment for case mix, if all children with splenic injuries in New Hampshire were treated in the same fashion as at the state's children's hospital, over 73% of splenectomies and 70% of splenorrhaphies performed for trauma may have been avoided.