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.
- subcapsular hematoma <10% of surface area
- parenchymal laceration <1 cm depth
- capsular tear
- subcapsular hematoma 10-50% of surface area
- intraparenchymal hematoma <5 cm
- parenchymal laceration 1-3 cm in depth
- subcapsular hematoma >50% of surface area
- ruptured subcapsular or intraparenchymal hematoma ≥5 cm
- parenchymal laceration >3 cm in depth
- 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
- 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.
- 1. Moore EE, Cogbill TH, Jurkovich GJ et-al. Organ injury scaling: spleen and liver (1994 revision). J Trauma. 1995;38 (3): 323-4. Article. Pubmed citation.
- 2. www.aast.org. Injury Scoring Scale. Read relevant article. Accessed on 08/06/2016
- 3. Madoff DC, Denys A, Wallace MJ et-al. Splenic arterial interventions: anatomy, indications, technical considerations, and potential complications. Radiographics. 2005;25 Suppl 1 : S191-211. doi:10.1148/rg.25si055504 - Pubmed citation
- 4. Kozar RA, Crandall M, Shanmuganathan K, Zarzaur BL, Coburn M, Cribari C, Kaup K, Schuster K, Tominaga GT. Organ injury scaling 2018 update: Spleen, liver, and kidney. (2018) The journal of trauma and acute care surgery. 85 (6): 1119-1122. doi:10.1097/TA.0000000000002058 - Pubmed
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