From the Guidelines
The grading of traumatic splenic injury is best classified using the American Association for the Surgery of Trauma (AAST) classification, which categorizes injuries into five grades based on the extent of damage, as outlined in the WSES classification guidelines 1. The AAST 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 This classification system is crucial in guiding management decisions, with lower grades (I-III) often managed non-operatively with close monitoring, while higher grades (IV-V) frequently require surgical intervention, as suggested by the WSES guidelines 1. Key considerations in management include the patient's hemodynamic stability, overall condition, and the presence of other injuries, as highlighted in the WSES position paper 1. The WSES classification provides a clear framework for categorizing splenic injuries, allowing for more effective management and improved patient outcomes, as supported by the guidelines 1.
From the Research
Grades of Traumatic Splenic Injury
The grades of traumatic splenic injury can be classified using various systems, including:
- The American Association for the Surgery of Trauma (AAST) organ injury scale, which is the most widely used grading system for blunt splenic injury 2
- The 'Baltimore CT grading system', which is superior to the AAST classification system in predicting the need for angiography and embolization or surgery 2
- A multidetector CT-based grading system, which can be used alone or in combination with clinical parameters to determine appropriate treatment for patients with blunt splenic injury 3
Classification Systems
The AAST and 'Baltimore CT grading system' have been shown to have high inter- and intraobserver reliability, with weighted Kappa coefficients of 0.80 and 0.85, respectively 2. The multidetector CT-based grading system has also been shown to be a reliable predictor of successful observation, with an area under the receiver operating characteristic curve (AUC) of 0.95 3.
Clinical Parameters
Clinical parameters, such as vital signs, laboratory values, and injury severity score, can also be used in combination with grading systems to determine appropriate treatment for patients with blunt splenic injury 3. For example, the combination of abbreviated injury scale score, systolic blood pressure reading, and serum glucose level has been shown to be a reliable triage model for decision making between splenectomy and splenic artery embolization (SAE) 3.