# AAST Pancreas — AAST Pancreas Organ Injury Scale

> Current grade I-V anatomic pancreatic-trauma scale replacing the 1990 location-heavy map. Grade I is edema or contusion without laceration; II has intact duct or a shallow uninvestigated laceration/hematoma; III and IV stratify injuries at the 50% depth and portal-vein/SMV boundaries with N/A/B duct subgrades; V is destructive nonviable head injury with A-D pancreatobiliary subgrades. CT appearance alone may not establish main-duct integrity, and grade does not autonomously prescribe treatment or prognosis.

**Situação:** vigente · **Órgão:** Pâncreas · **Órgão emissor:** American Association for the Surgery of Trauma · **Versão:** 2024 revision (published 2025); imaging context reviewed through 2026 · **Ano:** 2025

## Procedência e vigência
- Família: léxico
- Tipo de lógica: flat
- Modalidade: CT, MRI/MRCP, ERCP, Surgery, Pathology
- Fonte primária: Notrica DM, Tominaga GT, Gross JA, et al.. American Association for the Surgery of Trauma pancreatic organ injury scale: 2024 revision (2025) — https://pubmed.ncbi.nlm.nih.gov/39898876/
- Última verificação: 2026-07-24
- Última checagem: 2026-07-24

## Lógica de decisão
Use the 2024 revision with a main grade and subgrade, preserve the 50-percent and PV/SMV boundaries, and never infer duct integrity or treatment from CT grade alone.

## Categorias

| Código | Rótulo | Critérios | Conduta | Risco | Localizador | Verificado |
| --- | --- | --- | --- | --- | --- | --- |
| I | Grade I, edema or contusion without laceration | Pancreatic edema or contusion without laceration or hematoma. Subgrade I-A denotes traumatic edema and I-B denotes contusion without hematoma or laceration; head location no longer elevates an intact low-grade injury. | A hemodynamically stable patient without another laparotomy indication is generally considered for observation and nonoperative management, with reassessment when symptoms, enzymes or secondary imaging signs remain concerning. The current grade does not replace associated-injury evaluation. | Grade I is the least anatomic injury tier but does not guarantee absence of delayed pancreatic findings or complications. No portable patient-level fistula, pseudocyst or mortality percentage is encoded. | Notrica et al. 2025, DOI 10.1097/TA.0000000000004522, revised Table 1 grade I and I-A/I-B; Lanier and Mellnick 2026 for early-imaging limitations; WSES-AAST 2019 for stable-patient care context. | ✓ |
| II | Grade II, intact duct or shallow uninvestigated laceration/hematoma | Main pancreatic duct confirmed intact, or parenchymal laceration or hematoma less than 50% depth without definitive duct evaluation, or a lesion at least 50% deep with a definitively intact duct. Subgrade II-A is neck/body/tail and II-B is head/uncinate. | Stable grade II injury is often managed nonoperatively when no other operation is required, but a shallow uninvestigated lesion does not prove duct integrity. Escalate duct assessment when mechanism, depth, evolution or clinical findings could change care; laceration of the head with an intact duct is II-B rather than legacy grade IV. | Grade II contains both confirmed-intact-duct injuries and shallow lesions without definitive duct interrogation, so it is not one homogeneous risk group. Diagnostic delay and missed duct injury materially affect complications. | Notrica et al. 2025 revised Table 1, grade II and II-A/II-B; current imaging review for CT-versus-duct-evaluation limits; WSES-AAST 2019 management context, explicitly predating the new subgrades. | ✓ |
| III | Grade III, deep or ductal neck/body/tail injury | Main pancreatic duct injury or laceration or hematoma at least 50% deep in the neck, body or tail, defined as overlying or left of the portal vein or superior mesenteric vein. III-N lacks definitive duct evaluation, III-A has confirmed injury with maintained duct alignment, and III-B has complete transection or distracted ends. | Obtain early multidisciplinary trauma, hepatopancreatobiliary, interventional-endoscopy and radiology assessment. Resection, drainage, reconstruction, endoscopic therapy or selected nonoperative care depends on N/A/B duct status, exact location, physiology, age, associated injury, time from trauma and institutional expertise; grade III is not an automatic distal-pancreatectomy order. | Deep or confirmed ductal injury increases cohort complication burden, but III-N, III-A and III-B are clinically different and the revision is not a calibrated individual-risk model. Preserve duct uncertainty and associated injuries. | Notrica et al. 2025, revised Table 1 grade III, N/A/B subgrades and PV/SMV footnotes; Lanier and Mellnick 2026 for definitive duct-imaging emphasis; WSES-AAST 2019 for contextual management options. | ✓ |
| IV | Grade IV, deep or ductal head/uncinate injury | Main pancreatic duct injury or laceration or hematoma at least 50% deep in the head or uncinate, with any portion right of or posterior to the superior mesenteric vein. IV-N lacks definitive duct evaluation, IV-A has confirmed injury with alignment, and IV-B has complete transection or distraction. | Use urgent specialist and multidisciplinary planning, integrating duct subgrade, tissue viability, duodenal and biliary injury, hemorrhage, physiology and timing. Drainage, reconstruction, endoscopic therapy, resection or selected nonoperative strategies are context-dependent; current grade IV does not automatically require pancreaticoduodenectomy. | Grade IV identifies deep or ductal head/uncinate injury rather than a fixed prognosis. Outcome varies with partial versus complete duct injury, associated pancreatobiliary or vascular trauma, delay and center capability; no universal fistula or mortality percentage applies. | Notrica et al. 2025, revised Table 1 grade IV, IV-N/IV-A/IV-B and location footnotes; 2026 imaging review; WSES-AAST 2019 severe-injury management context, recognized as pre-revision guidance. | ✓ |
| V | Grade V, destructive nonviable pancreatic-head injury | Destructive blast or crush injury with nonviable pancreatic head. Use V-N when definitive pancreatobiliary duct assessment is unavailable; V-A for an intact main duct in the head, V-B for main pancreatic duct injury, V-C for intrapancreatic common bile duct injury, and V-D for ductal avulsion from the duodenum or sphincter disruption. | Trigger urgent damage-control and hepatopancreatobiliary planning while separately treating hemorrhage, contamination and associated duodenal, biliary and vascular injuries. The exact operation and timing depend on physiology, viability and reconstructive options; grade V alone does not mandate a Whipple procedure or establish futility. | Grade V is the highest destructive anatomic tier, but V-A through V-D represent distinct pancreatobiliary injuries and do not provide an individual survival or functional-outcome probability. Physiology and associated trauma remain decisive. | Notrica et al. 2025, revised Table 1 grade V and A-D duct subgrades with N uncertainty convention; current imaging review; WSES-AAST 2019 destructive-head management context interpreted cautiously because it predates the revision. | ✓ |

### Citações por categoria
- **I**: Notrica DM, Tominaga GT, Gross JA, et al.. American Association for the Surgery of Trauma pancreatic organ injury scale: 2024 revision (2025) — https://pubmed.ncbi.nlm.nih.gov/39898876/ · Notrica et al. 2025, DOI 10.1097/TA.0000000000004522, revised Table 1 grade I and I-A/I-B; Lanier and Mellnick 2026 for early-imaging limitations; WSES-AAST 2019 for stable-patient care context.
- **II**: Notrica DM, Tominaga GT, Gross JA, et al.. American Association for the Surgery of Trauma pancreatic organ injury scale: 2024 revision (2025) — https://pubmed.ncbi.nlm.nih.gov/39898876/ · Notrica et al. 2025 revised Table 1, grade II and II-A/II-B; current imaging review for CT-versus-duct-evaluation limits; WSES-AAST 2019 management context, explicitly predating the new subgrades.
- **III**: Notrica DM, Tominaga GT, Gross JA, et al.. American Association for the Surgery of Trauma pancreatic organ injury scale: 2024 revision (2025) — https://pubmed.ncbi.nlm.nih.gov/39898876/ · Notrica et al. 2025, revised Table 1 grade III, N/A/B subgrades and PV/SMV footnotes; Lanier and Mellnick 2026 for definitive duct-imaging emphasis; WSES-AAST 2019 for contextual management options.
- **IV**: Notrica DM, Tominaga GT, Gross JA, et al.. American Association for the Surgery of Trauma pancreatic organ injury scale: 2024 revision (2025) — https://pubmed.ncbi.nlm.nih.gov/39898876/ · Notrica et al. 2025, revised Table 1 grade IV, IV-N/IV-A/IV-B and location footnotes; 2026 imaging review; WSES-AAST 2019 severe-injury management context, recognized as pre-revision guidance.
- **V**: Notrica DM, Tominaga GT, Gross JA, et al.. American Association for the Surgery of Trauma pancreatic organ injury scale: 2024 revision (2025) — https://pubmed.ncbi.nlm.nih.gov/39898876/ · Notrica et al. 2025, revised Table 1 grade V and A-D duct subgrades with N uncertainty convention; current imaging review; WSES-AAST 2019 destructive-head management context interpreted cautiously because it predates the revision.

## Referências cruzadas
- _fronteira compartilhada_ → [AAST Spleen — AAST splenic injury scale](https://radcommons.laudos.ai/systems/aast-spleen.md) — Companion AAST organ injury scales for abdominal trauma.
- _fronteira compartilhada_ → [Revised Atlanta — Revised Atlanta classification of acute pancreatitis](https://radcommons.laudos.ai/systems/atlanta-pancreatitis.md) — AAST Pancreas 2024 grades traumatic anatomy and duct integrity. Revised Atlanta classifies acute-pancreatitis morphology, collections and clinical organ-failure severity; no grade or severity crosswalk is valid.

## Histórico de versões

| Data | Evento | Detalhe | Situação |
| --- | --- | --- | --- |
| 2026-01-01 | revised | The current imaging review clarified CT limitations and the increased role of definitive duct evaluation under the 2024 revision; it did not alter the grade table. | confirmed |
| 2025-02-03 | revised | AAST published the 2024 pancreas OIS revision, moving intact-duct head injuries to grade II and adding explicit depth, PV/SMV location and pancreatobiliary duct subgrades. | confirmed |
| 1990-11-01 | published | AAST published the original location-heavy pancreas OIS; it is retained as historical lineage and is no longer the current definition set. | confirmed |


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> Conteúdo de referência reescrito. Confira a publicação primária vigente. Não é dispositivo médico nem substitui o julgamento clínico. O radiologista responsável pelo laudo permanece o autor e o responsável.

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