Spleen Injury Scale

Evaluates traumatic splenic injury based on degree of laceration and hematoma.

Read more about this trauma injury grading system in the text below the tool.

The spleen injury scale is based on the AAST grading and evaluates degree of splenic injury caused by blunt or penetrative trauma.

There are five grades on the scale, each characterized by a different degree of laceration and hematoma.

This injury scale is the 1994 revision of the American Association for the Surgery of Trauma (AAST), and is built on results from CT scans, operative and autopsy findings.

Grades I and II are classed as minor injury and can usually be managed non-operatively.

Grade III is a moderate injury, again, managed non-operatively.

Grades IV and V are classed as severe injury and may require either an angioembolisation or splenectomy.

  ■ Subcapsular haematoma <10% of surface area;
  ■ Capsular laceration <1 cm depth.
  ■ Subcapsular haematoma 10-50% of surface area;
  ■ Intraparenchymal haematoma <5 cm in diameter;
  ■ Laceration 1-3 cm depth not involving trabecular vessels.
  ■ Subcapsular haematoma >50% of surface area or expanding;
  ■ Intraparenchymal haematoma >5 cm or expanding;
  ■ Laceration >3 cm depth or involving trabecular vessels;
  ■ Ruptured subcapsular or parenchymal haematoma.
  ■ Laceration involving segmental or hilar vessels with major devascularisation (>25% of spleen).
  ■ Shattered spleen;
  ■ Hilar vascular injury with devascularised spleen.
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AAST spleen grading

The above spleen injury scale is based on a 1994 revision by the American Association for the Surgery of Trauma (AAST).

It is the most widely used instrument in the evaluation of patients who suffered from splenic blunt or penetrative trauma.

The grading was created with findings from CT scans, operative notes and autopsy results. There are five grades of spleen injury, from the least severe (I) to the most severe (V):

AAST spleen injury grading Injury severity Description
Grade I Minor injury Subcapsular haematoma <10% of surface area;
Capsular laceration.
Grade II Subcapsular haematoma 10-50% of surface area;
Intraparenchymal haematoma;
Laceration 1-3 cm depth not involving trabecular vessels.
Grade III Moderate injury Subcapsular haematoma >50% of surface area or expanding;
Intraparenchymal haematoma >5 cm or expanding;
Laceration >3 cm depth or involving trabecular vessels;
Ruptured subcapsular or parenchymal haematoma.
Grade IV Severe injury Laceration involving segmental or hilar vessels with major devascularisation (>25% of spleen).
Grade V Shattered spleen; Hilar vascular injury with devascularised spleen.

The spleen injury evaluation is based on the degree and dimension of splenic laceration and the extent and depth of the hematoma. The injury grade is often used in decision making intraoperatively.

Lower grade injuries (grades I to III) are often managed non operatively whilst the higher grade injuries (IV and V) may require angioembolisation or splenectomy.

 

About traumatic spleen injury

The spleen is an abdominal organ placed in the left upper quadrant under the 9th to 12th pair of ribs. Along with the liver, it is the most commonly injured organ in abdominal trauma.

Blunt splenic trauma (the most common splenic injury) is caused by:

■ Motor vehicle accidents;

■ Domestic violence;

■ Bicycle accidents;

■ Contact sports.

Other injuries may be caused by a pre-existing injury or illness such as hematologic abnormalities. These lead to spleen enlargement which thins the splenic capsule making it prone to rupture.

Clinical presentation is often the same, with localized pain and tenderness in the left upper abdominal quadrant, rebound tenderness and diffuse abdominal pain. If nerves are involved, pain may irradiate towards the left shoulder.

Patients are checked for clear airways and have their vital signs taken to check whether they are hemodynamically stable or not, and if there are any signs of profuse bleeding (meaning that abdominal surgery may need to take place).

Computed tomography is the most used non invasive exploratory mean to observe the spleen and any trauma. The most frequent findings include:

■ hematoma incidence is 47%;

■ laceration incidence is 47%;

■ rupture occurs in 33.3% of cases.

CT testing can display intraperitoneal blood and if the bleeding exceeds 400 – 500 mL, signs of shock will accompany.

Because the splenic function is essential in filtrating red blood cells and it also offers immune system protection, conservationist treatment is preferred to splenectomy.

There have been increasing reports of damage to spleen caused by traumatic colonoscopy so there is discussion that colonoscopy should be added as spleen trauma risk factor.

 

Original source

Moore EE, Cogbill TH, Jurkovich GJ, Shackford SR, Malangoni MA, Champion HR. Organ injury scaling: spleen and liver (1994 revision). J Trauma. 1995; 38(3):323-4.

Other references

1. Aubrey-Bassler FK, Sowers N. 613 cases of splenic rupture without risk factors or previously diagnosed disease: a systematic review. BMC Emerg Med. 2012; 12:11.

2. Harbrecht BG, Zenati MS, Ochoa JB, Townsend RN, Puyana JC, Wilson MA, Peitzman AB. Management of adult blunt splenic injuries: comparison between level I and level II trauma centers. J Am Coll Surg. 2004; 198(2):232-9.

Specialty: Gastroenterology

System: Digestive

Objective: Evaluation

Type: Scale

No. Of Criteria: 5

Year Of Study: 1994

Article By: Denise Nedea

Published On: May 31, 2017 · 02:05 PM

Last Checked: May 31, 2017

Next Review: May 31, 2023