Description

Tominaga et al reported an updated injury scale for penetrating 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 contusion or hematoma

(2) wound track

(3) small bowel wall injury

(4) extraluminal oral contrast or intestinal material

(5) mesenteric findings

(6) enhancement of small bowel wall

(7) bleeding within small bowel lumen

 

Parameter

Finding

AAST Grade

contusion or hematoma

absesnt

0

 

present without devascularization

I

wound track

none

0

 

into peritoneum or retroperitoneum with nonphysiologic volume fluid

I

 

into peritoneum or retroperitoneum with small volume free fluid

II

 

into peritoneum or retroperitoneum with moderate or large  volumefree fluid

III

 

into peritoneum or retroperitoneum with moderate hemoperitoneum

IV

 

wound track leading to or abutting small bowel wall

IV

small bowel wall injury

none

0

 

serosal tear

I

 

full thickness injury without transection, contamination or peritonitis

II

 

full thickness injury without transection but with minimal contamination or peritonitis

III

 

transection with minimal contamination or peritonitis

IV

 

transection with destructive injury

V

 

transection with segmental tissue loss and significant peritonitis

V

extraluminal oral contrast or intestinal material

absent

0

 

present

V

mesenteric findings

none

0

 

isolated mesenteric fat streaking on imaging studies

II

 

hematoma adjacent to but not abutting bowel wall

III

enhancement of wall

present

0

 

absent

V

bleeding within small bowel lumen

absent

0

 

present

IV

 

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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