White blood cell and platelet counts can be used to differentiate between infection and the normal response after splenectomy for trauma: Prospective validation

Janie Weng, Carlos V R Brown, Peter Rhee, Ali Salim, Linda Chan, Demetrios Demetriades, George C. Velmahos

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Background: Transient elevations of the serum white blood cell count (WBC) and platelet count (PC) are normal physiologic responses after splenectomy. The clinician is often challenged to identify an infection in a postsplenectomy patient with an elevated WBC. A previous retrospective study found that a WBC greater than 15 × 103/μL and a PC/WBC ratio < 20 on postoperative day 5, in addition to an Injury Severity Score > 16, were highly associated with infection and should not be considered as part of the physiologic response to splenectomy. The current study intends to prospectively validate the WBC and PC/WBC ratio on postoperative day 5 as markers of infection after splenectomy for trauma. Methods: Consecutive trauma patients admitted to an urban, Level I trauma center who underwent splenectomy from June 2002 to December 2004 were collected prospectively. In addition to admission demographics, variables collected included daily WBC, PC, and PC/ WBC ratio during the first 10 postoperative days. Outcome was the presence of infection. Patients with infection (infected group) were compared with those without infection (noninfected group). Injury Severity Score > 16, postoperative day 5 WBC > 15 × 103/μL, and PC/WBC ratio < 20 were investigated as risk factors for postsplenectomy infection. Results: There were 96 trauma patients who underwent splenectomy during the study period, and 44 (46%) developed a postoperative infection. Infectious complications included pneumonia (n = 30 [31%]), followed by septicemia (n = 20 [21%]), urinary tract infection (n = 12 [13), abdominal abscess (n = 9 [9%]), and wound infection (n = 4 [4%]). Postoperative day 5 was the first day that infected patients had a higher WBC (16 ± 6 × 103/μL vs. 14 ± 4 × 103/μL, p = 0.03) and a lower PC/WBC ratio (15 ± 9 vs. 24 ± 12, p = 0.002) than noninfected patients. The presence of two or more risk factors for infection was associated with a 79% rate of infection, and no patient developed an infection if all three risk factors were absent. Conclusion: On postoperative day 5 after splenectomy for trauma, a WBC greater than 15 × 103/μL and a PC/WBC ratio less than 20 are reliable markers of infection.

Original languageEnglish (US)
Pages (from-to)1076-1080
Number of pages5
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume59
Issue number5
DOIs
StatePublished - Nov 2005

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Splenectomy
Platelet Count
Leukocyte Count
Wounds and Injuries
Infection
Blood Platelets
Abdominal Abscess
Injury Severity Score
Trauma Centers
Wound Infection
Urinary Tract Infections
Sepsis
Pneumonia
Retrospective Studies

Keywords

  • Infection
  • Leukocytosis
  • Sepsis
  • Spleen
  • Splenectomy

ASJC Scopus subject areas

  • Surgery

Cite this

White blood cell and platelet counts can be used to differentiate between infection and the normal response after splenectomy for trauma : Prospective validation. / Weng, Janie; Brown, Carlos V R; Rhee, Peter; Salim, Ali; Chan, Linda; Demetriades, Demetrios; Velmahos, George C.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 59, No. 5, 11.2005, p. 1076-1080.

Research output: Contribution to journalArticle

Weng, Janie ; Brown, Carlos V R ; Rhee, Peter ; Salim, Ali ; Chan, Linda ; Demetriades, Demetrios ; Velmahos, George C. / White blood cell and platelet counts can be used to differentiate between infection and the normal response after splenectomy for trauma : Prospective validation. In: Journal of Trauma - Injury, Infection and Critical Care. 2005 ; Vol. 59, No. 5. pp. 1076-1080.
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abstract = "Background: Transient elevations of the serum white blood cell count (WBC) and platelet count (PC) are normal physiologic responses after splenectomy. The clinician is often challenged to identify an infection in a postsplenectomy patient with an elevated WBC. A previous retrospective study found that a WBC greater than 15 × 103/μL and a PC/WBC ratio < 20 on postoperative day 5, in addition to an Injury Severity Score > 16, were highly associated with infection and should not be considered as part of the physiologic response to splenectomy. The current study intends to prospectively validate the WBC and PC/WBC ratio on postoperative day 5 as markers of infection after splenectomy for trauma. Methods: Consecutive trauma patients admitted to an urban, Level I trauma center who underwent splenectomy from June 2002 to December 2004 were collected prospectively. In addition to admission demographics, variables collected included daily WBC, PC, and PC/ WBC ratio during the first 10 postoperative days. Outcome was the presence of infection. Patients with infection (infected group) were compared with those without infection (noninfected group). Injury Severity Score > 16, postoperative day 5 WBC > 15 × 103/μL, and PC/WBC ratio < 20 were investigated as risk factors for postsplenectomy infection. Results: There were 96 trauma patients who underwent splenectomy during the study period, and 44 (46{\%}) developed a postoperative infection. Infectious complications included pneumonia (n = 30 [31{\%}]), followed by septicemia (n = 20 [21{\%}]), urinary tract infection (n = 12 [13), abdominal abscess (n = 9 [9{\%}]), and wound infection (n = 4 [4{\%}]). Postoperative day 5 was the first day that infected patients had a higher WBC (16 ± 6 × 103/μL vs. 14 ± 4 × 103/μL, p = 0.03) and a lower PC/WBC ratio (15 ± 9 vs. 24 ± 12, p = 0.002) than noninfected patients. The presence of two or more risk factors for infection was associated with a 79{\%} rate of infection, and no patient developed an infection if all three risk factors were absent. Conclusion: On postoperative day 5 after splenectomy for trauma, a WBC greater than 15 × 103/μL and a PC/WBC ratio less than 20 are reliable markers of infection.",
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AU - Weng, Janie

AU - Brown, Carlos V R

AU - Rhee, Peter

AU - Salim, Ali

AU - Chan, Linda

AU - Demetriades, Demetrios

AU - Velmahos, George C.

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N2 - Background: Transient elevations of the serum white blood cell count (WBC) and platelet count (PC) are normal physiologic responses after splenectomy. The clinician is often challenged to identify an infection in a postsplenectomy patient with an elevated WBC. A previous retrospective study found that a WBC greater than 15 × 103/μL and a PC/WBC ratio < 20 on postoperative day 5, in addition to an Injury Severity Score > 16, were highly associated with infection and should not be considered as part of the physiologic response to splenectomy. The current study intends to prospectively validate the WBC and PC/WBC ratio on postoperative day 5 as markers of infection after splenectomy for trauma. Methods: Consecutive trauma patients admitted to an urban, Level I trauma center who underwent splenectomy from June 2002 to December 2004 were collected prospectively. In addition to admission demographics, variables collected included daily WBC, PC, and PC/ WBC ratio during the first 10 postoperative days. Outcome was the presence of infection. Patients with infection (infected group) were compared with those without infection (noninfected group). Injury Severity Score > 16, postoperative day 5 WBC > 15 × 103/μL, and PC/WBC ratio < 20 were investigated as risk factors for postsplenectomy infection. Results: There were 96 trauma patients who underwent splenectomy during the study period, and 44 (46%) developed a postoperative infection. Infectious complications included pneumonia (n = 30 [31%]), followed by septicemia (n = 20 [21%]), urinary tract infection (n = 12 [13), abdominal abscess (n = 9 [9%]), and wound infection (n = 4 [4%]). Postoperative day 5 was the first day that infected patients had a higher WBC (16 ± 6 × 103/μL vs. 14 ± 4 × 103/μL, p = 0.03) and a lower PC/WBC ratio (15 ± 9 vs. 24 ± 12, p = 0.002) than noninfected patients. The presence of two or more risk factors for infection was associated with a 79% rate of infection, and no patient developed an infection if all three risk factors were absent. Conclusion: On postoperative day 5 after splenectomy for trauma, a WBC greater than 15 × 103/μL and a PC/WBC ratio less than 20 are reliable markers of infection.

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KW - Infection

KW - Leukocytosis

KW - Sepsis

KW - Spleen

KW - Splenectomy

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