top of page

BackTable / VI / Tool

AAST Spleen Injury Scale Grading

The AAST spleen injury scale is a critical tool used by trauma surgeons to assess and manage spleen injuries resulting from blunt abdominal trauma. Developed by the American Association for the Surgery of Trauma (AAST), this scale categorizes spleen injuries into five grades, ranging from minor lacerations to severe ruptures, guiding treatment decisions and predicting patient outcomes.

The 2018 revision of the AAST Spleen Injury Grading Scale is detailed below.

AAST Spleen Injury Scale Grading

AAST Spleen Injury Scale

AAST Spleen Injury Scale

Grade I AAST Spleen Injury

Minor injuries.

• Subcapsular Hematoma: <10% of surface area
• Parenchymal Laceration: <1 cm depth
• Capsular tear

Grade II AAST Spleen Injury

Moderate injuries.

• Subcapsular Hematoma: 10-50% of surface area
• Intraparenchymal Hematoma: <5 cm
• Parenchymal Laceration: 1-3 cm in depth

Grade III AAST Spleen Injury

More severe injuries.

• Subcapsular Hematoma:>50% of surface area
• Intraparenchymal Hematoma: ≥5 cm
• Parenchymal Laceration: >3 cm in depth
• Ruptured subcapsular or intraparenchymal hematoma

Grade IV AAST Spleen Injury

Injuries involving shattered spleen segments or lacerations involving segmental or hilar vessels with major devascularization.

• 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% devascularization

Grade V AAST Spleen Injury

The most severe injury.

• Shattered spleen
• Any injury in the presence of splenic vascular injury with active bleeding extending beyond the spleen into the peritoneum

Grading Notes

• Grade based on the highest grade assessment made on imaging, at operation, or on pathologic specimen.
• There may be more than one grade of spleen injury and the injury should be classified based on the higher grade of injury.
• For multiple injuries, advance one grade up to grade III.

Clinical Implications

The AAST spleen injury scale is instrumental in determining the appropriate treatment for spleen trauma:

• Grades I-III: Often managed conservatively, with careful monitoring and bed rest.
• Grades IV-V: May require surgical intervention, such as splenectomy or angioembolization, especially if the patient is hemodynamically unstable.
• This scale helps in predicting patient outcomes, with higher grades associated with increased morbidity and the need for more aggressive treatment.

Key Takeaways

The AAST spleen injury scale remains a cornerstone in the management of spleen injuries, offering a structured approach to assessment and treatment. Several studies have validated the AAST spleen injury scale's effectiveness, demonstrating its reliability in predicting outcomes and guiding clinical decision-making. Research shows that accurate grading correlates with patient prognosis, highlighting the scale's importance in improving trauma care. Its widespread use underscores its value in trauma care, providing a consistent method for evaluating injury severity and informing treatment strategies.

Learn more on the BackTable VI Podcast

BackTable is a knowledge resource for physicians by physicians. Get practical advice on the AAST Spleen Injury Scale Grading and how to build your practice by listening to the BackTable VI Podcast, reading exclusing BackTable Articles, and following the work of our Contributors.

Solid Organ & Pelvic Trauma
Ep 183 Solid Organ & Pelvic Trauma with Dr. Chris Ingraham
00:00 / 01:04

Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.

Related Podcasts

Ablation Technqiues for Acetabular Lesions with Dr. Jason Levy on the BackTable VI Podcast)
Musculoskeletal Tumor Embolizations with Dr. Gina Landinez on the BackTable VI Podcast)
Winning the Revenue Cycle Game with Teri Yates on the BackTable VI Podcast)
Mastering Microwave Ablation in HCC Treatment with Dr. Zach Berman on the BackTable VI Podcast)
Toolbox Essentials for CLI in the OBL with Dr. Kevin Herman on the BackTable VI Podcast)
Iliofemoral Stenting: Decision-Making & Best Practices Explored with Dr. Kush Desai and Dr. Steven Abramowitz on the BackTable VI Podcast)

Articles

Topics

bottom of page