Updated Spleen Organ Injury Scale

Description

Kozar et al reported an updated injury scale for splenic trauma

Detection may be based on CT, operative or pathologic findings

Parameters:

(1) subcapsular hematoma

(2) parenchymal laceration

(3) intraparenchymal hematoma

(4) vascular injury and/or bleeding

(5) parenchymal disruption

(6) other

Parameter	Finding	AAST Grade
subcapsular hematoma	none	0
	< 10% of surface area	I
	10 to 50% of surface area	II
	> 50% of surface area OR ruptured	III
parenchymal laceration	none	0
	less than 1 cm in depth	I
	1 to 3 cm depth	II
	> 3 cm in depth	III
	involving segmental or hilar vessels and causing > 25% devascularization	IV
	involves hilar vessels with devascularization	V
intraparenchymal hematoma	none	0
	< 5 cm in diameter	II
	>= 5 cm in diameter OR ruptured	III
vascular injury/bleeding	none	0
	presence of splenic vascular injury or active bleeding confined within splenic capsule	IV
	presence of splenic vascular injury or active bleeding beyond spleen into the peritoneum	V
parenchymal disruption	none	0
	shattered spleen	V
other	none	0
	capsular tear	I

If there are multiple injuries then increased grade by 1, up to Grade III (presumably refers to multiple Grade I or II lesions).

If more than one grade of injury is present then classify based by the higher/highest grade.

Vascular thrombosis can lead to organ infarction.

Vascular injury is defined as a pseudoaneurysm or arteriovenous fistula and appears as a focal collection of vascular contrast that decreases in attenuation with later images.

Active bleeding in images with contrast show an increase in size or attenuation with delayed images.

AAST Grade	AIS Severity
I	2
II	2
III	3
IV	4
V	5

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