Benjamin J. Booth, PhD
Office of Community Health Systems
Washington State Department of Health
Mauricio A. (Tony) Escobar, Jr., MD, FACS, FAAP
Chief of Staff, Mary Bridge Children’s Hospital
Pediatric Surgery Medical Director | Pediatric Trauma Medical Director
The Department of Health collaborated with past and current members of the Washington State Governor’s Emergency Medical Services and Trauma Care Steering Committee and the Pediatric Technical Advisory Committee to update an article published in 2006 by Bowman et al. entitled “Impact of a Statewide Quality Improvement Initiative in Improving the Management of Pediatric Splenic Injuries in Washington State.” Their work showed a reduction in pediatric splenectomies performed throughout the state, and at general trauma hospitals in particular, following a statewide quality improvement initiative to promote nonoperative management of pediatric spleen injuries in hemodynamically stable patients.
The current authors (Benjamin Booth, Stephen Bowman, Mauricio Escobar Jr., and Sam Sharar) sought to expand on the work by Bowman et al. by including a later time period to determine if the effects observed in the initial study persisted and to what extent the quality improvement initiative might need to be revisited. They found that pediatric splenectomies continued to decline in general trauma facilities throughout the state of Washington and that pediatric patients with blunt spleen injuries were considerably more likely to be treated at pediatric designated trauma facilities when compared to the period before the initiative. Their work demonstrated a lasting beneficial effect of the quality improvement initiative.
An additional benefit of the statewide QI initiative was that a regulatory approach was not needed in order to assure compliance. The initial guideline was developed and endorsed by the state Trauma Medical Directors group; it was originally adapted from Mary Bridge Children’s Hospital’s Nonoperative Splenic Management Guideline. Washington State’s guidelines for (1) Evaluation and Management of Blunt Abdominal Trauma, and (2) Pediatric Transfers were more recently updated in May 2017 and April 2012, respectively to reflect the evolving literature to guide splenic preservation in Washington State. These guidelines are available at https://www.doh.wa.gov/Portals/1/Documents/Pubs/530168.pdf and https://www.doh.wa.gov/portals/1/Documents/Pubs/530092.pdf, respectively.
This work was presented at the 4th annual Pediatric Trauma Society conference as a quick shot oral presentation and received very positive feedback.