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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
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.
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