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Background: Evidence based practice guidelines for the management of pediatric spleen injury (PSI) has evolved with successful nonoperative management. This study analyzed national trends in the management of pediatric PSI.
Methods: All children aged 0 to 18 years who were hospitalized with PSI were selected from nine years of National Inpatient Sample (NIS) database (2000-2008) and three years of Kid's Inpatient Database (KID) (2000, 2003, 2006). Rates of splenectomy, angiography, and transfusion were calculated and chronicled from 2000 to 2008.
Results: During the study period, the rate of splenectomy decreased from 18.25% to 10.86% (P<0.001). Changes in nonoperative management included more than two-fold increase in angiography, from 2.43% to 11.49% (P<0.001), and increase in transfusion, from 7.71% to 11.49% (P<0.001). Operative management was associated with increased length of stay (9.15 days versus 6.52 days, P<0.001) and higher mean total charge (\,981.26 versus \,156.30, P<0.001). Rural location cases were more likely to undergo operative management (1.242 OR, 1.176-1.312 CI, P<0.001), but less likely to undergo angiography (0.819 OR, 0.755-0.887 CI, P<0.001) and transfusion (0.957 OR, 0.905-1.012 CI, P<0.122).
Conclusion: Children with PSI are undergoing less splenectomy but more angiography and transfusion. Rural location may be an independent risk factor for operative management. Further studies are needed to assess for disparity in access and availability of aggressive nonoperative management.