From the Guidelines
The grades of splenic injury are classified into five categories based on the extent of damage, ranging from Grade I to Grade V, as defined by the American Association for the Surgery of Trauma (AAST) classification. The AAST classification is widely used to guide management decisions for splenic injuries, with the grade of injury influencing the likelihood of non-operative management (NOM) versus surgical intervention 1. The classification is as follows:
- Grade I: Hematoma Subcapsular, < 10% surface area, or Laceration Capsular tear, < 1 cm parenchymal depth
- Grade II: Hematoma Subcapsular, 10–50% surface area, or Intraparenchymal, < 5 cm diameter, or Laceration 1–3 cm parenchymal depth not involving a perenchymal vessel
- Grade III: Hematoma Subcapsular, > 50% surface area or expanding, or Ruptured subcapsular or parenchymal hematoma, or Intraparenchymal hematoma > 5 cm, or Laceration > 3 cm parenchymal depth or involving trabecular vessels
- Grade IV: Laceration of segmental or hilar vessels producing major devascularization (> 25% of spleen)
- Grade V: Laceration Completely shatters spleen, or Vascular Hilar vascular injury which devascularized spleen, as outlined in the WSES classification and guidelines for adult and pediatric patients 1. The management of splenic injuries has become increasingly conservative, with a focus on non-operative management for lower-grade injuries (I-III) and selective use of surgical intervention for higher-grade injuries (IV-V), particularly in hemodynamically unstable patients or those with evidence of active bleeding 1.
From the Research
Grades of Splenic Injury
The grades of splenic injury are classified based on the severity of the injury. According to the studies 2, 3, 4, 5, 6, the grades of splenic injury are as follows:
- Grade 1: Capsular treatment or minor hematomas
- Grade 2: Capsular or parenchymal injuries requiring topical hemostatic agents
- Grade 3: Parenchymal injuries requiring suture repair
- Grade 4: Parenchymal injuries requiring partial splenic resection
- Grade 5: Total splenic devascularization or uncontrollable bleeding from the splenic pedicle requiring splenectomy
Classification Systems
The classification systems used to grade splenic injuries include:
- The American Association for the Surgery of Trauma (AAST) organ injury scale, which is used to classify the severity of splenic injuries 5
- The grading system described by 2, which is based on the extent of splenic repair required
Key Points
Some key points to note about the grades of splenic injury are:
- The grade of splenic injury is an important factor in determining the management of the injury 3, 5
- The severity of associated injuries, such as orthopedic or intra-abdominal injuries, can also impact the management of splenic injuries 2, 4
- Angiography and embolization can be used to manage high-grade splenic injuries and improve nonoperative management success rates 3, 6