Citation

Chaudhari PP, Rodean J, Spurrier RG, Hall M, Marin JR, Ramgopal S, Alpern ER, Shah SS, Freedman SB, Cohen E, Morse RB, Neuman MI. Acad. Emerg. Med. 2022; ePub(ePub): ePub.

Copyright

(Copyright © 2022, Society for Academic Emergency Medicine, Publisher John Wiley and Sons)

DOI

10.1111/acem.14497

PMID

35373473

Abstract

BACKGROUND: Although more guideline-adherent care has been described in pediatric compared to adult trauma centers, we aimed to provide a more detailed characterization of management and resource utilization of children with intra-abdominal injury (IAI) within pediatric centers. Our primary objective was to describe the epidemiology, diagnostic evaluation, and management of children with IAI across U.S. children's hospitals. Our secondary objective was to describe the inter-hospital variation in surgical management of children with IAI.

METHODS: We conducted a cross-sectional study of 33 hospitals in the Pediatric Health Information System. We included children aged <18 years evaluated in the emergency department from 2010-2019 with IAI, as defined by ICD coding, and who underwent an abdominal computed tomography (CT). Our primary outcome was abdominal surgery. We categorized IAI by organ system and described resource utilization data. We used generalized linear regression to calculate adjusted hospital-level proportions of abdominal surgery, with a random effect for hospital.

RESULTS: We studied 9,265 children with IAI. Median (IQR) age was 9.0 years (IQR: 6.0, 13.0). Abdominal surgery was performed in 16% (n=1,479) of children, with the lowest proportion of abdominal surgery observed in children aged <5 years. Liver (38.6%) and spleen (32.1%) were the most common organs injured. 3.1% of children with liver injuries and 2.8% with splenic injuries underwent abdominal surgery. Although there was variation in rates of surgery across hospitals (p<0.001), only 3 of 33 hospitals had rates that were statistically different from the aggregate mean of 16%.

CONCLUSIONS: Most children with IAI are managed non-operatively, and most children's hospitals manage children with IAI similarly. These data can be used to inform future benchmarking efforts across hospitals to assess concordance with guidelines for the management of children with IAI.

Language: en