Impact of a statewide quality improvement initiative in improving the management of pediatric splenic injuries in washington state.

BACKGROUND

Evidence suggests that 90% of children with traumatic spleen injuries can be successfully managed nonoperatively. In Washington State, significant interhospital variation in pediatric spleen management led to the development and implementation of a statewide quality improvement initiative in 2002. We evaluated pediatric splenic injury management before and after the implementation of a statewide quality improvement initiative.

METHODS

Retrospective cohort study using data from the Washington Trauma Registry for years 1999-2001 (preintervention) and 2003-2005 (postintervention). Children ages 0 to 14 years who were hospitalized with a traumatic (noniatrogenic) splenic injury were included. Multivariable regression was used to control for patient and hospital characteristics.

RESULTS

Splenectomies were more common, occurring in 13.6% of children, in the preintervention period, compared with 7.8% in the postintervention period (p = 0.027). After adjusting for patient, injury, and hospital characteristics, children remained less likely to receive a splenectomy in the postintervention period than in the preintervention period (odds ratio 0.39, 95% confidence interval 0.19-0.82). Children cared for at pediatric trauma hospitals were less likely to receive splenectomy in both the preintervention and postintervention periods, compared with children treated at general trauma hospitals (p < 0.001). Splenectomy remained less common among children treated at pediatric-designated hospitals (odds ratio, 0.21; 95% confidence interval, 0.08-0.58) than among children treated in general trauma hospitals after controlling for intervention period.

CONCLUSION

The statewide quality improvement initiative was associated with a reduction in the rate of splenectomy in both pediatric and general trauma hospitals. However, general trauma hospitals remained more likely to perform splenectomies than hospitals with pediatric trauma designation.