Age and trauma center-specific disparities in splenectomy rates for pediatric trauma patients.

Background: Non-operative management (NOM) of blunt splenic injury (BSI) is the target for pediatric trauma care. Yet, the rates of splenectomy have historically been higher at non-pediatric trauma centers (PTCs). We sought to determine if this difference improved contemporaneously. Methods: Using the National Trauma Data Bank, 26 707 pediatric patients (age ≤18 years, 2013 to 2021) with BSI were identified and analyzed based on care at adult trauma centers (ATCs), dual trauma centers (DTCs), or pediatric trauma centers (PTCs) using descriptive statistics and logistic regressions. The primary outcome was splenectomy rate. Results: Of the 26 707 pediatric patients with BSI, 5569 (20.9%) were treated at PTCs, 11 904 (44.6%) at ATCs, and 9234 (34.6%) at DTCs. In a multivariable logistic regression model, pediatric patients had significantly higher odds of splenectomy at ATCs (OR 4.89; 95% CI 3.82 to 6.45) and DTCs (OR 3.31; 95% CI 2.57 to 4.31) versus PTCs. In a subanalysis, older patients (15 years to 18 years) also had a significantly higher odds of splenectomy at ATCs (OR 7.27; 95% CI 4.58 to 12.1) and DTCs (OR 5.10; 95% CI 3.18 to 8.57) versus PTCs. Of patients aged 15 years to 18 years the majority were treated at ATCs (58.6%) or DTCs (32.1%) compared with PTCs (9.3%), whereas 32.6% of patients aged <15 years were treated at PTCs. These differences persisted across the study period. Conclusion: Pediatric patients with BSI continue to have higher splenectomy rates when they are treated at ATCs and DTCs compared with PTCs. To improve these rates, healthcare systems should expand access to PTCs and investigate causality to improve pediatric trauma care rendered at ATCs and DTCs. Level of evidence: Level II.