Pancreatic trauma injury grading
Citation, DOI & article data
A number of pancreatic injury grading systems have been proposed for pancreatic trauma.
American Association for the Surgery of Trauma (AAST) 5,7
The proximal pancreas is defined as the gland to the right of the superior mesenteric vein (SMV)-portal vein axis whereas the distal pancreas is to the left of the axis. The term deep refers to an injury down to the level of the duct whereas superficial implies the injury is superficial to the duct 7.
- grade I: hematoma with minor contusion or superficial laceration without duct injury
- grade II: major contusion or laceration without duct injury
- grade III: distal transection or deep parenchymal injury with duct injury
- grade IV: proximal transection or deep parenchymal injury involving the ampulla (and/or intrapancreatic common bile duct)
- grade V: massive disruption of the pancreatic head ("shattered pancreas")
N.b. advance one grade for multiple injuries up to grade 3.
Grades I and II do not involve the duct and are considered low-grade injuries. Grades III, IV and V involve the duct and constitute high-grade injuries.
Wong et al. 3
A more simple method for grading severity on CT in pancreatic injury proposed by Wong et al. 3 is:
- grade A: pancreatitis or superficial laceration only
- BI: deep laceration involving pancreatic tail
- BII: complete transection of pancreatic tail
- CI: deep laceration involving pancreatic head
- CII: complete transection of pancreatic head
- 1. Linsenmaier U, Wirth S, Reiser M et-al. Diagnosis and classification of pancreatic and duodenal injuries in emergency radiology. Radiographics. 2008;28 (6): 1591-602. doi:10.1148/rg.286085524 - Pubmed citation
- 2. Wong YC, Wang LJ, Chen RJ et-al. Magnetic resonance imaging of extrahepatic bile duct disruption. Eur Radiol. 2002;12 (10): 2488-90. doi:10.1007/s00330-001-1296-8 - Pubmed citation
- 3. Wong YC, Wang LJ, Lin BC et-al. CT grading of blunt pancreatic injuries: prediction of ductal disruption and surgical correlation. J Comput Assist Tomogr. 21 (2): 246-50. J Comput Assist Tomogr (link) - Pubmed citation
- 4. Oniscu GC, Parks RW, Garden OJ. Classification of liver and pancreatic trauma. HPB (Oxford). 2006;8 (1): 4-9. doi:10.1080/13651820500465881 - Free text at pubmed - Pubmed citation
- 5. American Association for the Surgery of Trauma: Injury Scoring Scale
- 6. Ayoob AR, Lee JT, Herr K, LeBedis CA, Jain A, Soto JA, Lim J, Joshi G, Graves J, Hoff C, Hanna TN. Pancreatic Trauma: Imaging Review and Management Update. (2021) Radiographics : a review publication of the Radiological Society of North America, Inc. 41 (1): 58-74. doi:10.1148/rg.2021200077 - Pubmed