UMEM Educational Pearls

Category: Trauma

Title: Splenic Injury Grades

Keywords: Spleen, trauma, spleen injury grades (PubMed Search)

Posted: 8/19/2023 by Robert Flint, MD (Emailed: 8/20/2023) (Updated: 4/24/2024)
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Splenic injury treatment depends on the grade of injury. In general, grades 1 and 2 are non-operatively managed. Grades 4 and 5 tend to be managed operatively. Interventional radiology is used commonly for grade 3 and grades 1 and 2 if active contrast extravasation is seen.  Below is a refresher on splenic injury grading.

 

 

Table 1

Adaptation of AAST Organ Injury Scale for Spleen

Grade 

Injury type

Description of injury

I

Hematoma
Laceration

Subcapsular, <10% surface area
Capsular tear, <1 cm parenchymal depth

II

Hematoma

Subcapsular, 10% to 50% surface area
Intraparenchymal, <5 cm in diameter

Laceration

Capsular tear, 1 cm to 3 cm parenchymal depth that does not involve a trabecular vessel

III

Hematoma
Laceration 

Subcapsular, >50% surface are or expanding: ruptured subcapsular or parenchymal hematoma: intraparenchymal hematoma_>5 cm or expanding
3 cm parenchymal depth or involving trabecular vessels

IV

Laceration

Laceration involving segmental or hilar vessels producing major devascularization (>25% of spleen)

V

Laceration
Vascular

Completely shattered spleen
Hilar vascular injury with devascularizes spleen 

  • Adapted from American Association for the Surgery of Trauma organ injury scale for spleen.

References

1. An update on nonoperative management of the spleen in adults. BMJ Trauma Surgery and Acute Care Open. Volume 2, Issue 1.  Ben L Zarzaur, Grace S Rozycki

2. https://www.google.com/search?q=splenic+laceration+grading&rlz=1C9BKJA_enUS1063US1063&oq=splenic+laceration+grading&aqs=chrome..69i57j0i512l3j0i22i30l6.9531j0j4&hl=en-US&sourceid=chrome-mobile&ie=UTF-8#vhid=0ARTxhEO89dgGM&vssid=l