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 |
Specialty: Surgery, orthopedic, Emergency Medicine