Editing Splenic trauma (section)

== Grading: ==

* Either blunt or penetrating
* Producing either a subcapsular haematoma, laceration or vascular injury

{| class="wikitable"
|'''AAST Spleen Injury Scale (2018 revision)'''
|}
{| class="wikitable"
|Grade*
|AIS Severity
|'''Imaging Criteria (CT Findings)'''
|Operative Criteria
|Pathologic Criteria
|-
|I
|2
|'''Subcapsular hematoma <10% surface area''' 
|Subcapsular hematoma <10% surface area 
|Subcapsular hematoma <10% surface area 
|-
|
|
|'''Parenchymal laceration <1 cm depth'''
|Parenchymal laceration <1 cm depth
|Parenchymal laceration <1 cm depth
|-
|
|
|'''Capsular tear''' 
|Capsular tear 
|Capsular tear 
|-
|II
|2
|'''Subcapsular hematoma 10-50% surface'''

'''area; intraparenchymal hematoma <5 cm'''
|Subcapsular hematoma 10-50% surface

area; intraparenchymal hematoma <5 cm
|Subcapsular hematoma 10-50% surface

area; intraparenchymal hematoma <5 cm
|-
|
|
|'''Parenchymal laceration 1-3 cm'''
|Parenchymal laceration 1-3 cm
|Parenchymal laceration 1-3 cm
|-
|III 
|3 
|'''Subcapsular hematoma >50% surface area;'''

'''ruptured subcapsular or intraparenchymal'''

'''hematoma ≥5 cm'''
|Subcapsular hematoma >50% surface area or

expanding; ruptured subcapsular or

intraparenchymal hematoma ≥5 cm
|Subcapsular hematoma >50% surface area;

ruptured subcapsular or intraparenchymal

hematoma ≥5 cm
|-
|
|
|'''Parenchymal laceration >3 cm depth'''
|Parenchymal laceration >3 cm depth
|Parenchymal laceration >3 cm depth
|-
|IV
|4
|'''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
|Parenchymal laceration involving segmental or

hilar vessels producing >25% devascularization
|-
|
|
|'''Parenchymal laceration involving segmental or'''

'''hilar vessels producing >25% devascularization'''
|
|
|-
|V
|5 
|'''Any injury in the presence of a splenic vascular'''

'''injury with active bleeding extended beyond'''

'''the spleen into the peritoneum'''
|Hilar vascular injury with devascularizes

the spleen
|Hilar vascular injury with devascularizes

the spleen
|-
|
|
|'''Shattered spleen'''
|Shattered spleen
|Shattered spleen
|}
''Vascular injury is defined as a pseudoaneurysm or arteriovenous fistula and appears as a focal collection of vascular contrast that decreases in attenuation with delayed imaging. Active bleeding from a vascular injury presents as vascular contrast, focal or diffuse, that increases in size or attenuation in delayed phase. Vascular thrombosis can lead to organ infarction.''

''Grade based on highest grade assessment made on imaging, at operation or on pathologic specimen.''

''More than one grade of splenic injury may be present and should be classified by the higher grade of injury.''

''Advance one grade for multiple injuries up to grade III.''