The American Association for the Surgery of Trauma (AAST) splenic injury scale, revised in 2018, is the most widely used grading system for splenic trauma.
The 2018 update incorporates "vascular injury" (i.e. pseudoaneurysm, arteriovenous fistula) into the imaging criteria for visceral injury 4.
On this page:
Classification
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grade I
subcapsular hematoma <10% of surface area
parenchymal laceration <1 cm depth
capsular tear
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grade II
subcapsular hematoma 10-50% of surface area
intraparenchymal hematoma <5 cm
parenchymal laceration 1-3 cm in depth
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grade III
subcapsular hematoma >50% of surface area
intraparenchymal hematoma ≥5 cm
parenchymal laceration >3 cm in depth
ruptured subcapsular or intraparenchymal hematoma
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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
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grade V
shattered spleen
any injury in the presence of splenic vascular injury* with active bleeding extending beyond the spleen into the peritoneum
Additional points
advance one grade for multiple injuries, each up to grade III
vascular injury (i.e. pseudoaneurysm or AV fistula) appears as a focal collection of vascular contrast which decreases in attenuation on delayed images
active bleeding: focal or diffuse collection of vascular contrast which increases in size or attenuation on a delayed (i.e. later) phase
Imaging technique
The AAST guidelines recommend dual arterial/portal venous phase imaging for evaluation of a vascular injury of the liver, spleen, and kidney 4.
External links
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