Diagnosis of infection after splenectomy for trauma should be based on lack of platelets rather than white blood cell count.
BACKGROUND
There is a lack of evidence-based criteria to assist the diagnosis of infection following trauma splenectomy (TS). However, the literature suggests that white blood cell count (WBC) is associated with infection in patients who undergo TS. We sought to find whether there exist key differences in laboratory and clinical parameters that can assist the diagnosis of infection after TS.


METHODS
We evaluated all consecutive trauma patients who had undergone TS at a Level 1 trauma center from 2005 to 2011 for the development of infection. To do this, we compared the values of demographic, laboratory, and clinical variables of infected and non-infected patients on odd post-operative days (POD) in the period from 1-15 days after TS.


RESULTS
Of 127 patients who underwent TS, 25 died within 48 h after the procedure and were excluded from our analysis, leaving, 102 patients for investigation. In the 41 (40%) patients who developed an infection, the mean day for the first infectious episode was POD 7 (range, POD 4-14). The three most common infections were pneumonia (51%), urinary tract infection (24%), and bacteremia (20%). An evaluation of laboratory and clinical parameters showed no differences in the WBC of the patients who did and did not develop infections at any time in the 15 d after TS. However, the platelet count was statistically significantly higher in non-infected patients on POD 3-9 and on POD 13, and maximal body temperature was statistically significantly higher in the infected group of patients during the first week after TS. Differences in laboratory and clinical values of the infected and non-infected patients were greatest on POD 5.


CONCLUSIONS
Patients who undergo TS have high rates of infectious complications. The WBC is not a reliable predictor of infection in these patients in the 2 wks following TS. However, patients who do not develop infection after TS have statistically significantly higher absolute platelet counts and rates of change in their daily platelet counts than those who develop infection.
1 Department of Surgery, MetroHealth Medical Center Campus, University Hospitals Case Medical Center , Cleveland, Ohio.
Aman
A
Banerjee
Katherine B
KB
Kelly
Hannah Y
HY
Zhou
Shanteria D
SD
Dixon
Ariadni
A
Papana Dagiasis
Linda M
LM
Quinn
Jeffrey A
JA
Claridge
D000328:Adult; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D010976:Platelet Count; D013154:Spleen / Q000293:injuries* / Q000601:surgery*; D013156:Splenectomy / Q000009:adverse effects*; D013530:Surgical Wound Infection / Q000175:diagnosis* / Q000473:pathology