🩻 Splenic Injury Grading (AAST 2018)
This tool grades splenic injury I–V using the AAST 2018 Organ Injury Scale, which for the first time incorporates vascular injury (pseudoaneurysm/AVF) and active bleeding into the imaging criteria.
Management hinges on hemodynamic stability and overall injury burden, not the grade alone — operative indications are instability, peritonitis, or ongoing bleeding. (original synthesis · not guideline verbatim)
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When to use
Use in blunt abdominal trauma to assign a splenic injury grade and frame management — nonoperative monitoring, angioembolization, or surgery — always interpreted against hemodynamic stability.
How it works
Grade by the most severe finding (subcapsular/intraparenchymal hematoma size, laceration depth, vascular injury). I–II usually NOM; III NOM ± embolization; IV–V or instability → embolization/surgery.
Key points
- Management hinges on hemodynamic stability and overall injury burden, not the grade alone — operative indications are instability, peritonitis, or ongoing bleeding. (original synthesis · not guideline verbatim)
- Multiple injuries to the same organ may upgrade by one grade, up to grade III.
- The 2018 update folds vascular lesions into the scale, capturing pseudoaneurysm/AVF and active intracapsular bleeding.
References
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| Most severe imaging/operative finding | Grade I: subcapsular hematoma < 10% / laceration < 1 cm deep / capsular tear |
|---|
→AAST splenic injuryGrade I
- Grade：Grade I (the 2018 version incorporates vascular injury: pseudoaneurysm/AVF and active bleeding)
- Management direction：Usually nonoperative management (NOM): monitoring, serial exams and hemoglobin, premised on hemodynamic stability
- Multiple injuries：Multiple injuries to the same organ may upgrade by one grade, up to grade III
| Most severe imaging/operative finding | Grade V: shattered spleen / vascular injury with active bleeding extending beyond the spleen into the peritoneum |
|---|
→AAST splenic injuryGrade V
- Grade：Grade V (the 2018 version incorporates vascular injury: pseudoaneurysm/AVF and active bleeding)
- Management direction：Hemodynamically unstable or grade IV–V active bleeding → angioembolization or surgery (splenorrhaphy/splenectomy)
- Multiple injuries：Multiple injuries to the same organ may upgrade by one grade, up to grade III
Frequently asked questions
- What is Splenic Injury Grading (AAST 2018)?
- This tool grades splenic injury I–V using the AAST 2018 Organ Injury Scale, which for the first time incorporates vascular injury (pseudoaneurysm/AVF) and active bleeding into the imaging criteria.
- How is Splenic Injury Grading (AAST 2018) calculated? What is the core formula?
- Grade by the most severe finding (subcapsular/intraparenchymal hematoma size, laceration depth, vascular injury). I–II usually NOM; III NOM ± embolization; IV–V or instability → embolization/surgery.
- When is Splenic Injury Grading (AAST 2018) used?
- Use in blunt abdominal trauma to assign a splenic injury grade and frame management — nonoperative monitoring, angioembolization, or surgery — always interpreted against hemodynamic stability.
- What are the key clinical points for Splenic Injury Grading (AAST 2018)?
- Management hinges on hemodynamic stability and overall injury burden, not the grade alone — operative indications are instability, peritonitis, or ongoing bleeding. (original synthesis · not guideline verbatim) Multiple injuries to the same organ may upgrade by one grade, up to grade III. The 2018 update folds vascular lesions into the scale, capturing pseudoaneurysm/AVF and active intracapsular bleeding.
- What are the limits and cautions when using Splenic Injury Grading (AAST 2018)?
- For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
- How is Splenic Injury Grading (AAST 2018) calculated in practice? Can you show a worked example?
- Inputs: Most severe imaging/operative finding Grade I: subcapsular hematoma < 10% / laceration < 1 cm deep / capsular tear → Result: AAST splenic injury Grade I（Grade: Grade I (the 2018 version incorporates vascular injury: pseudoaneurysm/AVF and active bleeding), Management direction: Usually nonoperative management (NOM): monitoring, serial exams and hemoglobin, premised on hemodynamic stability, Multiple injuries: Multiple injuries to the same organ may upgrade by one grade, up to grade III） Inputs: Most severe imaging/operative finding Grade V: shattered spleen / vascular injury with active bleeding extending beyond the spleen into the peritoneum → Result: AAST splenic injury Grade V（Grade: Grade V (the 2018 version incorporates vascular injury: pseudoaneurysm/AVF and active bleeding), Management direction: Hemodynamically unstable or grade IV–V active bleeding → angioembolization or surgery (splenorrhaphy/splenectomy), Multiple injuries: Multiple injuries to the same organ may upgrade by one grade, up to grade III）