AAST spleen injury scale

The 2018 revision of the American Association for the Surgery of Trauma (AAST) splenic injury scale is currently the most widely used grading system for splenic trauma. The following is the imaging criteria for classification based on CT findings.

Classification

  • grade I
  • grade II
    • subcapsular haematoma 10-50% of surface area
    • intraparenchymal haematoma <5 cm
    • parenchymal laceration 1-3 cm in depth
  • grade III
    • subcapsular haematoma >50% of surface area
    • ruptured subcapsular or intraparenchymal haematoma ≥5 cm
    • parenchymal laceration >3 cm in depth
  • grade IV
    • any injury in the presence of a splenic vascular injury* or active bleeding confined within splenic capsule
    • parenchymal laceration involving segmental or hilar vessels producing >25% devascularisation
  • grade V
    • shattered spleen
    • any injury in the presence of splenic vascular injury* with active bleeding extending beyond the spleen into the peritoneum

N.b. advance one grade for multiple injuries up to grade III.

More than one grade of injury may be present and should be classified as the higher grade.

*Vascular injury refers to a pseudoaneurysm or AV fistula that appears as a focal collection of vascular contrast, focal or diffuse, and increases in size or attenuation in delayed phase.

See also

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Article information

rID: 2074
Synonyms or Alternate Spellings:
  • AAST splenic injury grading system
  • Grading of splenic injury

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Cases and figures

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    FIgure 1: splenic trauma grading: diagrams
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    Case 1: grade I
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    Case 2: grade II
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    Case 3: grade III
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    Case 4: grade IV
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    Case 5: grade IV
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    Case 6: grade V
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    Case 7: grade V
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