From the Guidelines
The grades of splenic laceration are I, II, III, IV, and V, as classified by the American Association for the Surgery of Trauma (AAST) 1.
Splenic Laceration Grades
- 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 parenchymal 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 The WSES classification groups splenic injury into minor, moderate, and severe, which can be used to guide treatment decisions 1.
WSES Classification
- Minor: AAST grades I–II, stable hemodynamic status
- Moderate: AAST grade III, stable hemodynamic status
- Severe: AAST grades IV–V, or hemodynamic instability 1.
From the Research
Grades of Splenic Laceration
The grades of splenic laceration are classified using the American Association for the Surgery of Trauma (AAST) Organ Injury Scale, which includes the following grades:
- Grade I: Hematoma or laceration that is minor and does not involve the parenchyma of the spleen
- Grade II: Hematoma that is greater than 50% surface area of the spleen or laceration that is less than 10 cm in depth
- Grade III: Hematoma that is ruptured and involves the parenchyma of the spleen or laceration that is greater than 10 cm in depth
- Grade IV: Laceration that involves the segmental or hilar vessels of the spleen
- Grade V: Shattered spleen or devascularization of the spleen 2, 3, 4, 5, 6
Key Points
- The AAST grading system is widely used to classify splenic injuries, but there may be variability in interpretation among radiologists 2
- The management of splenic injuries depends on the grade of the injury, with nonoperative management often recommended for low-grade injuries (Grade I-III) and surgical intervention or splenic angioembolization recommended for high-grade injuries (Grade IV-V) 3, 4, 5, 6
- The success rate of nonoperative management varies depending on the grade of the injury, with higher success rates for lower-grade injuries 3, 6