Bowman Stephen M, Bulger Eileen, Sharar Sam R, Maham Sabrina A, Smith Samuel D
Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, USA.
Arch Surg. 2010 Nov;145(11):1048-53. doi: 10.1001/archsurg.2010.228.
Although nonoperative management is the standard of care for hemodynamically stable children with blunt splenic trauma, significant variation in practice exists. Little attention has been given to physician factors associated with management differences.
Nationally representative mail survey conducted in June 2008.
United States.
Ten percent random sample of active, dues-paying fellows in the American College of Surgeons.
Knowledge, attitudes, and beliefs toward pediatric splenic injury management, including the role of clinical practice guidelines.
Almost all of the 375 responding surgeons (97.4%) agreed that surgical intervention is not immediately necessary for hemodynamically stable children. However, surgeons reported significant disagreement regarding whether blood should be administered before operative intervention for hemodynamically unstable children and whether explorative surgery is needed for stable patients with evidence of contrast extravasation on computed tomography. Only 18.7% of surgeons reported being very familiar with the clinical practice guidelines for the management of pediatric blunt splenic trauma from either the Eastern Association for the Surgery of Trauma or the American Pediatric Surgical Association. Surgeons who were very familiar with either guideline were significantly more likely to rate the guidelines as beneficial (90.0% vs 72.8%, P = .002).
General surgeons reported varying degrees of familiarity with and use of clinical practice guidelines for pediatric splenic injury management. Limited pediatric experience and lack of pediatric hospital resources may limit more widespread adoption of nonoperative management. Targeted educational interventions may help increase surgeon knowledge of guidelines and best practices.
尽管非手术治疗是血流动力学稳定的儿童钝性脾外伤的标准治疗方法，但实际操作中存在很大差异。与管理差异相关的医生因素很少受到关注。
2008年6月进行的全国代表性邮件调查。
美国。
美国外科医师学会10%的在职、缴纳会费的会员随机样本。
对小儿脾损伤管理的知识、态度和信念，包括临床实践指南的作用。
375名回复的外科医生中几乎所有人（97.4%）都认为，血流动力学稳定的儿童无需立即进行手术干预。然而，对于血流动力学不稳定的儿童在手术干预前是否应输血，以及CT显示有造影剂外渗的稳定患者是否需要进行探查性手术，外科医生们存在很大分歧。只有18.7%的外科医生表示非常熟悉东部创伤外科学会或美国小儿外科学会关于小儿钝性脾外伤管理的临床实践指南。非常熟悉任何一项指南的外科医生更有可能认为这些指南有益（90.0%对72.8%，P = 0.002）。
普通外科医生对小儿脾损伤管理的临床实践指南的熟悉程度和使用程度各不相同。有限的儿科经验和儿科医院资源的缺乏可能会限制非手术治疗的更广泛采用。有针对性的教育干预可能有助于增加外科医生对指南和最佳实践的了解。
