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: 5/2/2024)
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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
II	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