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Spleen Injury Scale

Description

Traumatic injury to the spleen can be graded using the Spleen Injury Scale. The original scale proposed in 1989 was revised in 1994.


 

Original Scale from 1989

 

Type

Subtype

Description of Injury

Grade

hematoma

subcapsular

< 10% of surface area, nonexpanding

I

 

 

10-50% of surface area, nonexpanding

II

 

 

> 50% of surface area, nonexpanding

III

 

 

expanding

III

 

 

ruptured with active bleeding

III

 

intra-parenchymal

< 2 cm in diameter, nonexpanding

II

 

 

>= 2 cm in diameter, nonexpanding

III

 

 

expanding

III

 

 

ruptured with active bleeding

IV

laceration

parenchyma

capsular tear < 1 cm depth, nonbleeding

I

 

 

capsular tear 1-3 cm in depth, not involving a trabecular vessel, with active bleeding

II

 

 

> 3 cm parenchymal depth

III

 

 

involving trabecular vessels

III

 

 

involving segmental or hilar vessels, with major devascularization of the spleen (> 25% of spleen)

IV

 

 

completely shattered spleen

V

vascular

 

hilar vascular injury which devascularizes the spleen

V

 

If multiple injuries are present to the liver, then advance the grade by one.

 

Revised Scale from 1994

 

Type

Subtype

Description of Injury

Grade

hematoma

subcapsular

< 10% of surface area

I

 

 

10-50% of surface area

II

 

 

> 50% of surface area, nonexpanding

III

 

 

expanding

III

 

 

ruptured

III

 

intra-parenchymal

< 5 cm in diameter

II

 

 

>= 5 cm in diameter, nonexpanding

III

 

 

expanding

III

 

 

ruptured

IV

laceration

parenchyma

capsular tear < 1 cm depth

I

 

 

capsular tear 1-3 cm in depth, not involving a trabecular vessel

II

 

 

> 3 cm parenchymal depth

III

 

 

involving trabecular vessels

III

 

 

involving segmental or hilar vessels, with major devascularization of the spleen (> 25% of spleen)

IV

 

 

completely shattered spleen

V

vascular

 

hilar vascular injury which devascularizes the spleen

V

 

If multiple injuries are present to the liver, then advance the grade by one, up to grade III.

 

where:

• Differences of revised from initial scale: (1) removal of "nonbleeding" and "nonexpanding" for Grades I and II; (2) intraparenchymal hematoma measure changed from 2 to 5 cm; (3) "with active bleeding" removed from tear 1-3 cm in length and from ruptured hematomas;

• I am assuming that a Grade II lesion can be upgraded to Grade III, but not Grade III to Grade IV (see Testis Injury Scale).

 


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Specialty

ICD-10