Over the weekend, I heard about the tragic death of New Jersey high school quarterback Evan Murray. No information was released about the cause of death, so I followed the story closely for information. I concluded, largely based on the events on and off the field that Murray had suffered a head injury and died from a hemorrhage between the skull and the brain. I thought that cardiac arrest or heat stroke, the other common causes of death in football, were unlikely given the description of his collapse. When the coroner announced this week that a
lacerated spleen caused massive bleeding that led to death, I decided to write about this uncommon tragedy for my newspaper column in hopes of raising awareness of splenic injuries.
Autopsy results released Monday afternoon offered an explanation for the death of a New Jersey high school quarterback shortly after he 
walked off the field.
Evan Murray, a 17-year-old three-sport athlete at Warren Hills Regional High School took a hit in the backfield during the second quarter Friday night. According to witnesses who spoke to the media, Murray walked off under his own power but later collapsed. As he was placed on a stretcher to be taken to a local hospital, he told his teammates he would be fine and gave them the thumbs-up sign.
Evan Murray was soon pronounced dead.
According to a statement released by the Morris County Coroner’s Office, the cause of death was a lacerated spleen that caused a massive intra-abdominal hemorrhage. Dr. Ronald Suarez found that Murray’s spleen was abnormally enlarged, making it more susceptible to injury.
Causes of death in high school and college football
Deaths due to spleen injuries are rare in football. Over a 20-year-period ending in 2010, 243 deaths occurring in high school and college football in the United States were reported to the National Center for Catastrophic Sports Injury Research. Cardiac failure accounted for 41% of the deaths. Brain injuries made up 25%, and heat illness comprised 15%. Only two players died from splenic rupture.
Also read:
7 questions about infectious mononucleosis (mono) and return to sports
Prevent heat deaths in summer football practice now
Many causes of death in the sport proved to be more common than what killed Murray. Asthma, sickle cell trait, blood clots, cervical spine fractures, infection and lightning all caused more football deaths over those 20 years. That’s right. You are more likely to be struck by lightning and die.
Recent spleen ruptures in the NFL
Spleen ruptures do occur, though. Last season, Tennessee Titans wide receiver Justin Hunter suffered a ruptured spleen after a big hit from a Houston Texans safety. He stayed in the game for two quarters before he was taken to the hospital.
In 2006, Tampa Bay Buccaneers quarterback Chris Simms had his spleen removed after rupturing it in a game against the Carolina Panthers. He left the game for two plays after several hard hits, but he returned and played into the fourth quarter.
Mechanism of spleen injuries
The spleen is the most frequently injured abdominal organ in sports. A direct blow to the left side of the upper abdomen in contact or collision sports like football can injure the spleen in a healthy athlete. If the spleen is enlarged from an infection like mononucleosis (“mono”), a blood disorder or other cause, it is more vulnerable to blunt trauma.
Recognition of spleen injuries
Recognition and prompt treatment of injured athletes is crucial. It is estimated that at any given moment, one unit of the body’s 12 units of 
blood is in the spleen. Laceration or rupture, then, can lead to massive bleeding into the abdomen that can be catastrophic.
Spleen injuries can be hard to diagnose at the time of injury. A player might have upper left abdominal pain after a hard tackle to the body. He might complain of left shoulder pain from blood irritating the diaphragm. A doctor or athletic trainer might find tenderness when feeling the abdomen or ribs over the spleen.
Recognition and treatment of athletes with spleen injuries
Unfortunately the exam is often unremarkable right after the trauma. Therefore it is vital for medical providers with the athlete, or parents if the athlete is at home, to assess the athlete many times in the ensuing minutes and hours. Evaluation of the athlete at a hospital is critical if there is any question of a serious injury.
Also read:
Risk of sudden cardiac death in athletes
Common questions about CTE and traumatic brain injuries in sports
Many athletes with ruptured spleens require surgery and sometimes removal of the spleen, like Chris Simms did. Others with stable vital signs can be treated without surgery, like Justin Hunter was. These athletes usually do well and lead healthy lives, often returning to sports.
Hope for a positive outcome
Evan Murray’s death has devastated an entire community in Washington, New Jersey. Maybe one positive outcome will result from this tragedy. Parents, coaches and athletes can become more aware of these injuries so that no more athletes die from them in the future.
Note: This article appears in a modified form as my sports medicine column in the September 29, 2015 issue of The Post and Courier.
References:
Boden BP, Breit I, Beachler JA, Williams A, Mueller FO. Fatalities in high school and college football players. Am J Sports Med. 2013 May;41(5):1108-16.
Juyia RF, Kerr HA. Return to play after liver and spleen trauma. Sports Health. 2014 May;6(3):239-45.
Ralston DJ, Scherm MJ. Splenic Artery Avulsion in a High School Football Player: A Case Report. J Athl Train. 2004 Jun;39(2):201-205.
Coroner reveals N.J. high school QB’s cause of death. CBS/Associated Press. September 28, 2015.
Bucs’ Simms has spleen removed after loss to Carolina. ESPN.com. September 25, 2006.
Justin Hunter back at full strength after spleen injury. FOX Sports. June 12, 2015.
