Splenic Trauma in the Israeli Defense Forces - Do Not Underestimate Minor Trauma.

Background: The spleen is the most commonly damaged abdominal organ following blunt abdominal trauma (BAT), usually involving a major injury mechanism. Several cases of splenic rupture caused by minor BAT in the Israeli Defense Forces (IDF) have recently occurred. This led us to explore the demographics and mechanisms of trauma resulting in splenic injury among IDF personnel.

Methods: All cases of splenic injury between 2007 and 2015 were pulled from the computerized patient records of the IDF. Data regarding patient demographics, injury mechanism, presenting symptoms, treatment, and outcomes were collected. Three independent physicians graded the injury mechanism as major or minor.

Results: Fifty-two cases of splenic injury were identified. Of them, 82.7% resulted from a blunt trauma, 9.6% occurred after a penetrating trauma and 7.7% occurred spontaneously. 37.2% of BAT were unanimously considered as minor. Patients who suffered minor trauma were more likely to experience delayed diagnosis (85.7% vs. 0% p < 0.0001) and had significantly less concomitant injuries (12.5% vs. 88.8% p < 0.0001). The presentation, treatment, and outcome of the patients were similar, regardless of the severity of trauma mechanism.

Conclusion: Our findings indicate that although minor BAT results from a milder traumatic mechanism, it is a significant cause of splenic injury among active duty personnel. We suggest that military physicians maintain a high level of suspicion while managing minor BAT cases.