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Comparative Study
. 2004 Feb;198(2):232-9.
doi: 10.1016/j.jamcollsurg.2003.10.007.

Management of adult blunt splenic injuries: comparison between level I and level II trauma centers

Brian G Harbrecht  1 , Mazen S Zenati, Juan B Ochoa, Ricard N Townsend, Juan C Puyana, Mark A Wilson, Andrew B Peitzman
Affiliations
Comparative Study

Management of adult blunt splenic injuries: comparison between level I and level II trauma centers

Brian G Harbrecht et al. J Am Coll Surg. 2004 Feb.

Abstract

Background: The factors important in determining outcome when managing adult blunt splenic injuries continue to be debated. Whether trauma center level designation (Level I versus Level II) affects patient management has not been evaluated.

Study design: We conducted a retrospective analysis of prospectively gathered data from the Pennsylvania Trauma Outcome Study database that collected information from 27 statewide trauma centers (Level I [15], Level II [17]). Adult patients (ages > or = 16 years) with blunt splenic injuries (ICD-9-CM 865) were evaluated. Demographic data, injury data, and trauma center level designation were collected, and patient management, length of stay, and mortality were analyzed.

Results: There were 2,138 adult patients who suffered blunt splenic injuries during the study period (1998-2000). Patients treated at Level II trauma centers (n = 772) had a higher rate of operative treatment (38.2% versus 30.7%) (p < 0.001), but a shorter mean length of stay (10.1 +/- 0.4 versus 12.0 +/- 0.4 days) (p < 0.01) compared with patients in Level I trauma centers (n = 1,366). The rate of failure of nonoperative treatment was lower at Level II trauma centers (13.0% versus 17.6%) (p < 0.05), but the mortality for patients managed nonoperatively was higher (8.4% versus 4.5%) (p < 0.05). Splenorrhaphy was performed more frequently in Level I trauma centers.

Conclusions: Management differences exist in the treatment of adult blunt splenic injuries between institutions of different trauma center level designation. Multicenter studies should account for this finding in design and implementation.

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