AAST injury scoring scales

Tushar Garg and Dr Craig Hacking et al.

The American Association for the Surgery of Trauma (AAST) injury scoring scales are the most widely accepted and used system of classifying and categorising traumatic injuries. Injury grade reflects severity, guides management, and aids in prognosis. Currently (early 2019), 32 different injury scores are available.

Classification

The most commonly used injury scoring grades are for the solid viscera: 

Injury is classified according to either imaging, operative, or pathologic criteria - the highest classification is assigned the final AAST grade 2. Grading of spleen, liver, and kidney injuries has been validated, with increasing grades of injury correlating with increasing mortality, operative rate, and hospitalisation cost 3

Other scales are less commonly used, including:

  • cervical vascular injury
  • chest wall
  • heart 
  • lung 
  • thoracic vascular injury
  • diaphragm 
  • extrahepatic biliary tree 
  • oesophagus 
  • stomach 
  • small bowel 
  • colon 
  • rectum 
  • abdominal vascular injury
  • ureter 
  • bladder 
  • urethra 
  • uterus
    • pregnant
    • non-pregnant 
  • fallopian tube 
  • ovary 
  • vagina 
  • vulva 
  • testis 
  • scrotum 
  • penis 
  • peripheral vascular organ injury

History and etymology

Early efforts to create an organised system for describing and grading traumatic organ injuries included 4:

  • Abbreviated Injury Scale - developed in 1971 in collaboration with the automotive industry to improve vehicle safety, as well as the
  • Injury Severity Score - developed in 1974, first to predict survival
  • Abdominal Trauma Index - developed in 1981, updated for blunt trauma in 1990, organ-specific injury grading, estimating morbidity/mortality

In the last 1980s, the AAST formed an Organ Injury Scale (OIS) committee comprising trauma, orthopaedic surgery, urology, and neurosurgery specialists in order to create a more comprehensive classification.

The first AAST OIS guidelines published in 1989 classified injuries of spleen, liver, and kidney 5.

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Article information

rID: 40904
Synonyms or Alternate Spellings:
  • American Association for the Surgery of Trauma injury grading scores
  • injury grading scores
  • injury score
  • injury grading
  • injury scores
  • injury scoring scales

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