Background: Pediatric trauma surgeons have been the vanguard of non-operative management of blunt splenic injuries. However, there is no uniform consensus on the determination of failure of non-operative management and variability exists in management strategies across institutions. We hypothesized that centers with a pediatric surgical fellowships would be less likely to pursue surgical management of blunt splenic injuries than other trauma centers without fellowship programs. Study Design: The Pediatric Health Information System (PHIS) was queried for all patients 15 years old or younger admitted with splenic injuries between 2016-2024. Penetrating injuries were excluded. ICD-10 diagnostic codes were used to estimate injury severity score (ISS). Primary outcome was splenic surgery or embolization identified by ICD-10-PCS code. Results: There were 6,853 patients identified with blunt splenic injury of whom 319 (4.7%) underwent either splenic surgical intervention or percutaneous endovascular embolization. There was significant variability in rates of splenic intervention among institutions, with fellowship training hospitals having significantly lower rates of intervention (4.2% vs 6.3%, p<0.01). Multivariable logistic regression, controlling for patient demographics, injury severity, and hospital characteristics, demonstrated that patients with severe splenic injuries treated at hospitals with a fellowship were less likely to undergo splenectomy (OR 0.37, 95% CI 0.20-0.66, p<0.01) or endovascular intervention (OR 0.45, 95% CI 0.22-0.91, p=0.03). Conclusions: In the setting of significant interinstitutional variability in the management of pediatric blunt splenic injury, institutions with pediatrics surgical fellowship training programs are more likely to successfully pursue non-operative management even when controlling for injury severity and patient demographics.
Hellmann et al. (2026) studied this question.