Management of splenic injury in children and young adults: a survey of surgeons investigating factors responsible for variations in care using the Theoretical Domains Framework
Bibliographic record
Abstract
STRUCTURED ABSTRACT Objective: To identify differences in practice and behavioural drivers in adult and paediatric surgeons related to the management of splenic injury in children and young people. Background: Despite the existence of guidelines, there are variations in the care of children with splenic injuries. There are no specific guidelines for the care of young adults, who may be managed according to either paediatric or adult practices. The drivers of variation in trauma management between adult and paediatric surgeons have not been examined through an implementation science lens. Methods: The COM-B model of behaviour and theoretical domains framework were used to construct a survey which was delivered to a cross-section of adult general surgeons and paediatric surgeons working in public hospitals throughout NSW, Australia. The capability, opportunity, and motivation for management decisions were analysed. Outcome variables were compared between the practitioner groups. Statistical significance was set at p < 0.05. Results: Eighty (26.4%) responses met the inclusion criteria. Significant differences between adult and paediatric surgeons were identified in terms of: capability (surgeon training and experience); opportunity (hospital, personnel, and resources); and motivation (comfort with splenic injury care at different ages). In managing splenic injury, pediatric surgeons tended to follow pediatric guidelines while adult surgeons followed adult guidelines, making some adjustments for age. All agreed guidelines had the potential to improve care. Conclusions: This study identified several behavioural drivers for observed variations in the care of splenic injury in children and young adults. The results indicate that contextually relevant guidelines for managing splenic injury in children and young people across any setting may be needed to reduce disparities in care. These should be underpinned by interventions designed to further address the drivers of surgeon behaviour to optimise uptake. Furthermore, splenic injury care is a clinical indicator of the quality of trauma care more broadly. Addressing variation in its care has the potential to translate to other trauma system improvements. HIGHLIGHTS Unwarranted variations in splenic injury management have been reported. This is the first examination of surgeon behaviour in the provision of trauma care through an implementation science lens. Differences in the capability, opportunity, and motivation of surgeons in providing evidence-based care to children and young adults with splenic injury were found. Contextually relevant guidelines, underpinned by supporting interventions addressing these behavioural drivers, are needed to reduce disparities in care.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".