{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T16:55:54Z","timestamp":1789664154283,"version":"4.0.1"},"reference-count":14,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[2019,9,24]],"date-time":"2019-09-24T00:00:00Z","timestamp":1569283200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Sports Health: A Multidisciplinary Approach"],"published-print":{"date-parts":[[2019,11]]},"abstract":"\n Background:<\/jats:title>\n 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 We examined actual timing of mononucleosis-associated splenic injury using a large repository of unpublished patient data.<\/jats:p>\n <\/jats:sec>\n \n Hypothesis:<\/jats:title>\n The risk of splenic injury after infectious mononucleosis will remain elevated longer than previously estimated.<\/jats:p>\n <\/jats:sec>\n \n Study Design:<\/jats:title>\n Retrospective case series.<\/jats:p>\n <\/jats:sec>\n \n Level of Evidence:<\/jats:title>\n Level 4.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n 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 (\u00b113.5) 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.<\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Clinical Relevance:<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>","DOI":"10.1177\/1941738119873665","type":"journal-article","created":{"date-parts":[[2019,9,24]],"date-time":"2019-09-24T17:26:54Z","timestamp":1569346014000},"page":"543-549","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":32,"title":["Association of Splenic Rupture and Infectious Mononucleosis: A Retrospective Analysis and Review of Return-to-Play Recommendations"],"prefix":"10.1177","volume":"11","author":[{"given":"Jillian E.","family":"Sylvester","sequence":"first","affiliation":[{"name":"St Louis University (Southwest Illinois) Family Medicine Residency, O\u2019Fallon, Illinois"},{"name":"Department of Family Medicine, Uniformed Services University, Bethesda, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin K.","family":"Buchanan","sequence":"additional","affiliation":[{"name":"National Capitol Consortium Primary Care Sports Medicine Fellowship, Uniformed Services University of Health Sciences, Bethesda, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott L.","family":"Paradise","sequence":"additional","affiliation":[{"name":"Naval Hospital Camp Pendleton Sports Medicine Fellowship, Camp Pendleton, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua J.","family":"Yauger","sequence":"additional","affiliation":[{"name":"Department of Clinical Systems Support, Fort Belvoir Community Hospital, Fort Belvoir, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony I.","family":"Beutler","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Uniformed Services University, Bethesda, Maryland"},{"name":"Intermountain Health, Provo, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2019,9,24]]},"reference":[{"key":"bibr1-1941738119873665","doi-asserted-by":"publisher","DOI":"10.1016\/j.csm.2004.02.005"},{"key":"bibr2-1941738119873665","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2015.10.071"},{"key":"bibr3-1941738119873665","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9343(00)00560-X"},{"key":"bibr4-1941738119873665","unstructured":"Centers for Disease Control and Prevention. Burden of tobacco use in the U.S. Centers for Disease Control and Prevention website. https:\/\/www.cdc.gov\/tobacco\/campaign\/tips\/resources\/data\/cigarette-smoking-in-united-states.html. Updated January 30, 2018. Accessed July 2, 2018."},{"key":"bibr5-1941738119873665","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-199707000-00003"},{"key":"bibr6-1941738119873665","doi-asserted-by":"publisher","DOI":"10.1016\/S0095-4543(21)00177-9"},{"key":"bibr7-1941738119873665","doi-asserted-by":"publisher","DOI":"10.1136\/bjsm.2008.050807"},{"key":"bibr8-1941738119873665","doi-asserted-by":"publisher","DOI":"10.1001\/archpediatrics.2010.144"},{"key":"bibr9-1941738119873665","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.136.1.111"},{"key":"bibr10-1941738119873665","doi-asserted-by":"publisher","DOI":"10.1249\/00149619-200204000-00009"},{"key":"bibr11-1941738119873665","doi-asserted-by":"publisher","DOI":"10.1097\/JSM.0b013e3181f35fe5"},{"key":"bibr12-1941738119873665","doi-asserted-by":"publisher","DOI":"10.1097\/JSM.0b013e31817e34f8"},{"key":"bibr13-1941738119873665","first-page":"234","volume":"14","author":"Rea TD","year":"2001","journal-title":"J Am Board Fam Pract"},{"key":"bibr14-1941738119873665","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2016.03.043"}],"container-title":["Sports Health: A Multidisciplinary Approach"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1941738119873665","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/1941738119873665","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1941738119873665","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T22:43:17Z","timestamp":1777588997000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/1941738119873665"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,9,24]]},"references-count":14,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2019,11]]}},"alternative-id":["10.1177\/1941738119873665"],"URL":"https:\/\/doi.org\/10.1177\/1941738119873665","relation":{},"ISSN":["1941-7381","1941-0921"],"issn-type":[{"value":"1941-7381","type":"print"},{"value":"1941-0921","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,9,24]]}}}