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Frequency of splenectomy for pediatric splenic injury in Brazil: a retrospective analysis.
Telles, Luiza; Gerk, Ayla; Carroll, Madeleine; Faleiro, Matheus Daniel; Barbosa de Oliveira, Thais; Naus, Abbie; Ferreira, Roseanne; Botelho, Fabio; Bustorff-Silva, Joaquim; Mooney, David P; Ferreira, Julia.
Afiliación
  • Telles L; Instituto de Educação Médica (IDOMED/Estácio, Campus Vista Carioca), Rio de Janeiro, RJ, Brazil.
  • Gerk A; Harvard Medical School, Program in Global Surgery and Social Change, Boston, MA, United States.
  • Carroll M; Department of Surgical and Interventional Sciences, McGill University, Quebec, Canada.
  • Faleiro MD; Harvey E. Beardmore Division of Pediatric Surgery, Montreal Children's Hospital, Quebec, Canada.
  • Barbosa de Oliveira T; Harvard Medical School, Program in Global Surgery and Social Change, Boston, MA, United States.
  • Naus A; Yale New Haven Hospital, New Haven, CT, United States.
  • Ferreira R; Universidade Federal de Minas Gerais, UFMG, Belo Horizonte, MG, Brazil.
  • Botelho F; Universidade Federal da Bahia, UFBA, Salvador, BA, Brazil.
  • Bustorff-Silva J; Harvard Medical School, Program in Global Surgery and Social Change, Boston, MA, United States.
  • Mooney DP; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.
  • Ferreira J; Harvey E. Beardmore Division of Pediatric Surgery, Montreal Children's Hospital, Quebec, Canada.
Lancet Reg Health Am ; 36: 100844, 2024 Aug.
Article en En | MEDLINE | ID: mdl-39170858
ABSTRACT

Background:

Non-operative management for pediatric blunt splenic injury is well established in high-income countries, leading to a low splenectomy rate in hemodynamically stable children. Splenectomy rate became a quality indicator for Trauma Center verification utilized by the American College of Surgeons Committee on Trauma. However, data on splenectomy rate in children from countries with different income levels, such as Brazil, remain limited. This study aimed to assess the post-traumatic splenectomy rate among Brazilian children over the past decade and the relation with local resources.

Methods:

Data on pediatric splenic injuries and splenectomies from 2008 to 2019, including patient age and admitting service (adult or pediatric), were obtained from FioCruz database, a public, free, cloud-based platform that offers extensive national health data. The regional numbers of pediatric surgeons, pediatric intensive care unit (PICU) beds, and computed tomography scanners were obtained from Brazilian national databases. A national analysis of splenectomy rate by year and service of admission and an analysis of splenectomy rate by the level of regional resources, the number of pediatric surgeons, PICU beds, and computed tomography scanners was performed.

Findings:

4061 children were hospitalized with a splenic injury, and 2287 (51.8%) of them underwent splenectomy, unchanged over time. 76.8% were male and 23.1% female patients with splenic injury. Mean age was 11.61 years old. The odds of splenectomy was 14.77 times higher for pediatric patients admitted under adult surgical service compared to pediatric service (OR = 14.77, 95% CI 11.75-18.56, p < 0.0001). The overall increase in pediatric surgeons, PICU beds, and CT scanner availability did not correspond with changes in splenectomy rate.

Interpretation:

The post-traumatic splenectomy rate among Brazilian children is high, far exceeding that of high-income countries. Increased regional pediatric resources did not correspond to a decrease in splenectomy rate. Further research is essential to understand Brazil's barriers to adopting non-operative management for pediatric splenic injuries.

Funding:

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE País/Región como asunto: America do sul / Brasil Idioma: En Revista: Lancet Reg Health Am Año: 2024 Tipo del documento: Article País de afiliación: Brasil Pais de publicación: Reino Unido
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE País/Región como asunto: America do sul / Brasil Idioma: En Revista: Lancet Reg Health Am Año: 2024 Tipo del documento: Article País de afiliación: Brasil Pais de publicación: Reino Unido