Jillian E Sylvester1,2, Benjamin K Buchanan3, Scott L Paradise4, Joshua J Yauger5, Anthony I Beutler2,6. 1. St Louis University (Southwest Illinois) Family Medicine Residency, O'Fallon, Illinois. 2. Department of Family Medicine, Uniformed Services University, Bethesda, Maryland. 3. National Capitol Consortium Primary Care Sports Medicine Fellowship, Uniformed Services University of Health Sciences, Bethesda, Maryland. 4. Naval Hospital Camp Pendleton Sports Medicine Fellowship, Camp Pendleton, California. 5. Department of Clinical Systems Support, Fort Belvoir Community Hospital, Fort Belvoir, Virginia. 6. Intermountain Health, Provo, Utah.
Abstract
BACKGROUND: Infectious mononucleosis is typically a self-limited disease commonly affecting young adults. Splenic rupture is a rare but serious complication affecting 0.1% to 0.5% of patients with mononucleosis. Current guidelines (based on published case reports) recommend complete activity restriction for 3 weeks after onset of mononucleosis symptoms to reduce rupture risk. We examined actual timing of mononucleosis-associated splenic injury using a large repository of unpublished patient data. HYPOTHESIS: The risk of splenic injury after infectious mononucleosis will remain elevated longer than previously estimated. STUDY DESIGN: Retrospective case series. LEVEL OF EVIDENCE: Level 4. METHODS: The Military Health System Management Analysis and Reporting Tool (M2) was used to conduct a retrospective chart review. Coding records of TRICARE beneficiaries aged 5 to 65 years between 2006 and 2016 were screened. Patients diagnosed with both splenic injury and mononucleosis-like symptoms were identified, and their medical records were reviewed for laboratory confirmation of infection and radiographically evident splenic injury. RESULTS: A total of 826 records of splenic injury were found in M2. Of these, 42 cases met the study criteria. Mean time to splenic injury was 15.4 (±13.5) days. Only 73.8% (n = 31) of injuries occurred within 21 days, and 90.5% (n = 38) of splenic injuries occurred within 31 days of symptom onset. CONCLUSION: A substantial number of splenic injuries occur between 21 and 31 days after symptom onset. While most splenic injuries were atraumatic, consideration should be given to extending return-to-play guidelines to 31 days after symptom onset to minimize risk. Risk of chronic pain after splenic injury may be higher than previously believed. CLINICAL RELEVANCE: The risk for postmononucleosis splenic injuries remains elevated longer than current guidelines suggest. Restricting activity for 31 days after mononucleosis symptom onset may reduce the risk of splenic injury.
BACKGROUND: Infectious mononucleosis is typically a self-limited disease commonly affecting young adults. Splenic rupture is a rare but serious complication affecting 0.1% to 0.5% of patients with mononucleosis. Current guidelines (based on published case reports) recommend complete activity restriction for 3 weeks after onset of mononucleosis symptoms to reduce rupture risk. We examined actual timing of mononucleosis-associated splenic injury using a large repository of unpublished patient data. HYPOTHESIS: The risk of splenic injury after infectious mononucleosis will remain elevated longer than previously estimated. STUDY DESIGN: Retrospective case series. LEVEL OF EVIDENCE: Level 4. METHODS: The Military Health System Management Analysis and Reporting Tool (M2) was used to conduct a retrospective chart review. Coding records of TRICARE beneficiaries aged 5 to 65 years between 2006 and 2016 were screened. Patients diagnosed with both splenic injury and mononucleosis-like symptoms were identified, and their medical records were reviewed for laboratory confirmation of infection and radiographically evident splenic injury. RESULTS: A total of 826 records of splenic injury were found in M2. Of these, 42 cases met the study criteria. Mean time to splenic injury was 15.4 (±13.5) days. Only 73.8% (n = 31) of injuries occurred within 21 days, and 90.5% (n = 38) of splenic injuries occurred within 31 days of symptom onset. CONCLUSION: A substantial number of splenic injuries occur between 21 and 31 days after symptom onset. While most splenic injuries were atraumatic, consideration should be given to extending return-to-play guidelines to 31 days after symptom onset to minimize risk. Risk of chronic pain after splenic injury may be higher than previously believed. CLINICAL RELEVANCE: The risk for postmononucleosis splenic injuries remains elevated longer than current guidelines suggest. Restricting activity for 31 days after mononucleosis symptom onset may reduce the risk of splenic injury.
Entities:
Keywords:
mononucleosis; return to play; rupture; splenomegaly
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