Tominaga et al reported an updated injury scale for blunt small bowel trauma.The authors are from multiple institutions in the United States and the AAST Patient Assessment Committee.
Detection may be based on CT, operative or pathologic findings
Parameters:
(1) small bowel wall thickening
(2) small bowel wall hematoma
(3) free air
(4) extraluminal oral contrast or intestinal material
(5) wall laceration
(6) other
Parameter
Finding
AAST Grade
small bowel wall thickening
none
0
focal without free fluid or devascularization
I
focal with small volume free fluid
II
focal with moderate to large volume of free fluid
III
focal with adjacent interloop free fluid
III
small bowel wall hematoma
none
0
without free fluid or devascularization
I
with small volume free fluid
II
with moderate to large volume of free fluid
III
with adjacent interloop free fluid
III
free air
none
0
pneumoperitoneum or pneumo-retroperitoneum
IV
extraluminal oral contrast or intestinal material
none
0
present
IV
wall laceration
none
0
serosal tear
I
full thickness injury without contamination
II
full thickness injury with minimal contamination
III
wall defect or bowel transection
IV
transection with destructive small bowel injury including devasculariation
V
transection with segmental tissue loss and peritonitis
V
other
none
0
lack of contrast of small bowel wall on CT
V
For adult with Grade II or IV injury: upgrade 1 grade for >= 8 hour delay in diagnosis from time of injury
AAST Grade
AIS Severity
I
2
II
3
III
3
IV
4
V
5
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