Return to play after liver and spleen trauma

Area of Science:

• Sports Medicine
• Abdominal Trauma
• Diagnostic Imaging

Background:

• Sport-related spleen and liver injuries are rare but can be life-threatening.
• Lack of evidence-based guidelines for activity restriction and return to play exists.
• Controversy surrounds follow-up imaging protocols for these injuries.

Purpose of the Study:

• To review current literature on managing blunt splenic and hepatic injuries in athletes.
• To provide recommendations for diagnosis, management, and return to play.
• To address the controversy regarding follow-up imaging.

Main Methods:

• Literature search of PubMed (1980-2013) using terms for splenic/spleen trauma and hepatic/liver trauma.
• Review of citations from key publications.
• Clinical review of Level 3 evidence.

Main Results:

• Ultrasound is optimal for unstable athletes; contrast-enhanced CT is preferred for stable athletes.
• Nonoperative management is suitable for stable patients, irrespective of injury grade or associated injuries.
• Follow-up imaging is not routinely recommended; gradual return to activity over 3 months is advised.

Conclusions:

• Contrast-enhanced CT is the preferred diagnostic tool for stable athletes with blunt abdominal trauma.
• Nonoperative management is a safe and effective strategy for hemodynamically stable athletes.
• Clear guidelines for return to play and judicious use of follow-up imaging are essential.