AAST spleen injury scale
Updates to Article Attributes
The American Association for the Surgery of Trauma (AAST) splenic injury scale, most recently revised in 2018, is currently 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.
Classification
-
grade I
subcapsular haematoma <10% of surface area
parenchymal laceration <1 cm depth
capsular tear
-
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 orintraparenchymal haematoma ≥5 cm
parenchymal laceration >3 cm in depth
ruptured subcapsular or intraparenchymal haematoma
-
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
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.
-<p>The <strong>American Association for the Surgery of Trauma (AAST)</strong> <strong>splenic injury scale</strong>, most recently revised in 2018, is currently the most widely used grading system for <a href="/articles/splenic-trauma">splenic trauma</a>.</p><p>The 2018 update incorporates "vascular injury" (i.e. <a href="/articles/false-aneurysm">pseudoaneurysm</a>, <a href="/articles/arteriovenous-fistula">arteriovenous fistula</a>) into the imaging criteria for visceral injury <sup>4</sup>.</p><h4>Classification</h4><ul>-<li>-<strong>grade I</strong><ul>-<li>-<a href="/articles/subcapsular-splenic-haematoma">subcapsular haematoma</a> <10% of surface area</li>-<li>parenchymal laceration <1 cm depth</li>-<li>capsular tear</li>-</ul>-</li>-<li>-<strong>grade II</strong><ul>-<li>-<a href="/articles/subcapsular-splenic-haematoma">subcapsular haematoma</a> 10-50% of surface area</li>-<li>intraparenchymal haematoma <5 cm</li>-<li>parenchymal laceration 1-3 cm in depth</li>-</ul>-</li>-<li>-<strong>grade III</strong><ul>-<li>-<a href="/articles/subcapsular-splenic-haematoma">subcapsular haematoma</a> >50% of surface area</li>-<li>ruptured subcapsular or intraparenchymal haematoma ≥5 cm</li>-<li>parenchymal laceration >3 cm in depth</li>-</ul>-</li>-<li>-<strong>grade IV</strong><ul>-<li>any injury in the presence of a splenic vascular injury* or active bleeding confined within splenic capsule</li>-<li>parenchymal laceration involving segmental or hilar vessels producing >25% devascularisation</li>-</ul>-</li>-<li>-<strong>grade V</strong><ul>-<li>shattered spleen</li>-<li>any injury in the presence of splenic vascular injury* with active bleeding extending beyond the spleen into the peritoneum</li>-</ul>-</li>-</ul><h5>Additional points</h5><ul>-<li>advance one grade for multiple injuries, each up to grade III</li>-<li>"vascular injury" (i.e. pseudoaneurysm or AV fistula) appears as a focal collection of vascular contrast which decreases in attenuation on delayed images</li>-<li>"active bleeding" - focal or diffuse collection of vascular contrast which increases in size or attenuation on a delayed (i.e. later) phase</li>- +<p>The <strong>American Association for the Surgery of Trauma (AAST)</strong> <strong>splenic injury scale</strong>, most recently revised in 2018, is currently the most widely used grading system for <a href="/articles/splenic-trauma">splenic trauma</a>.</p><p>The 2018 update incorporates "vascular injury" (i.e. <a href="/articles/false-aneurysm">pseudoaneurysm</a>, <a href="/articles/arteriovenous-fistula">arteriovenous fistula</a>) into the imaging criteria for visceral injury <sup>4</sup>.</p><h4>Classification</h4><ul>
- +<li>
- +<p><strong>grade I</strong></p>
- +<ul>
- +<li><p><a href="/articles/subcapsular-splenic-haematoma">subcapsular haematoma</a> <10% of surface area</p></li>
- +<li><p>parenchymal laceration <1 cm depth</p></li>
- +<li><p>capsular tear</p></li>
- +</ul>
- +</li>
- +<li>
- +<p><strong>grade II</strong></p>
- +<ul>
- +<li><p><a href="/articles/subcapsular-splenic-haematoma">subcapsular haematoma</a> 10-50% of surface area</p></li>
- +<li><p>intraparenchymal haematoma <5 cm</p></li>
- +<li><p>parenchymal laceration 1-3 cm in depth</p></li>
- +</ul>
- +</li>
- +<li>
- +<p><strong>grade III</strong></p>
- +<ul>
- +<li><p><a href="/articles/subcapsular-splenic-haematoma">subcapsular haematoma</a> >50% of surface area</p></li>
- +<li><p>intraparenchymal haematoma ≥5 cm</p></li>
- +<li><p>parenchymal laceration >3 cm in depth</p></li>
- +<li><p>ruptured subcapsular or intraparenchymal haematoma</p></li>
- +</ul>
- +</li>
- +<li>
- +<p><strong>grade IV</strong></p>
- +<ul>
- +<li><p>any injury in the presence of a splenic vascular injury* or active bleeding confined within splenic capsule</p></li>
- +<li><p>parenchymal laceration involving segmental or hilar vessels producing >25% devascularisation</p></li>
- +</ul>
- +</li>
- +<li>
- +<p><strong>grade V</strong></p>
- +<ul>
- +<li><p>shattered spleen</p></li>
- +<li><p>any injury in the presence of splenic vascular injury* with active bleeding extending beyond the spleen into the peritoneum</p></li>
- +</ul>
- +</li>
- +</ul><h5>Additional points</h5><ul>
- +<li><p>advance one grade for multiple injuries, each up to grade III</p></li>
- +<li><p>"vascular injury" (i.e. pseudoaneurysm or AV fistula) appears as a focal collection of vascular contrast which decreases in attenuation on delayed images</p></li>
- +<li><p>"active bleeding" - focal or diffuse collection of vascular contrast which increases in size or attenuation on a delayed (i.e. later) phase</p></li>
Unable to process the form. Check for errors and try again.