The article by Bowman et al is a thoughtful attempt to assess individual general surgeon practice as an explanation for the much higher rates of splenectomy in hospital settings, outside of children's hospitals. The authors polled actively practicing general surgeons across the United States about their knowledge of “best practice” guidelines for the nonoperative management of splenic injuries in children. In addition, they queried the surgeons about their agreement with said guidelines, the diagnostic testing used, barriers to using these practice guidelines, and their perception of the value of best practice guidelines.
Colombani PM. Similar to Politics, “Safest Surgical Practice” Is Local: Comment on “Variability in Pediatric Splenic Injury Care”. Arch Surg. 2010;145(11):1053–1054. doi:10.1001/archsurg.2010.226