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AAST Spleen AAST splenic injury scale

vigente

Grades splenic injury severity on CT.

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Escala de categorias

I II III IV V

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Procedência e vigência

Órgão emissor: American Association for the Surgery of Trauma
Versão: 2018
Ano: 2018
Família: léxico
Tipo de lógica: flat
Modalidade: CT
Fonte primária: Organ injury scaling 2018 update: spleen, liver, and kidney (AAST) · doi:10.1097/TA.0000000000002058
Última verificação: 2026-06-26
Última checagem: 2026-06-26

Lógica de decisão

Forma estruturada (flat). Uma futura calculadora a lê; as categorias abaixo são a superfície legível.

Mostrar a lógica estruturada (JSON)

{
  "categories": [
    "I",
    "II",
    "III",
    "IV",
    "V"
  ]
}

Categorias num relance

Cat.	Significado	Conduta	Risco	Fonte
I	Grade I Minor injury: subcapsular hematoma covering less than 10% of the splenic surface area, and/or a parenchymal laceration under 1 cm deep, and/or a simple capsular tear.	Low-grade injury (WSES minor, grades I-II): nonoperative management is the standard of care in hemodynamically stable patients - observation with serial vitals/hemoglobin. Splenic angioembolization is reserved for a contrast blush/vascular injury; surgery only for hemodynamic instability or failed NOM.	Lowest-risk tier: nonoperative management succeeds in roughly 95-99% of low-grade injuries; overall NOM success across blunt splenic trauma is up to about 80%.	okfonte Management grouping (low-grade I-II = NOM, embolization for blush) per WSES spleen classification PMC6580626 and StatPearls 'Splenic Injury' NBK441993; NOM success up to 80% overall per NBK441993.
II	Grade II Subcapsular hematoma involving 10-50% of surface area, or an intraparenchymal hematoma smaller than 5 cm; and/or a parenchymal laceration 1-3 cm deep.	Low-grade injury (WSES minor, grades I-II): nonoperative management in stable patients with serial monitoring; splenic artery angioembolization when CT shows a contrast blush, pseudoaneurysm, or AV fistula. Operative management (splenectomy/splenorrhaphy) reserved for instability or NOM failure.	Low-risk tier with high NOM success; a contrast blush raises failure risk - low-grade injuries with active extravasation may fail NOM in up to ~20% if not embolized.	okfonte Low-grade NOM/embolization grouping per WSES PMC6580626 and StatPearls NBK441993; ~20% NOM failure with blush per EAST multicenter study PMC10921525.
III	Grade III Subcapsular hematoma exceeding 50% of surface area, or a ruptured subcapsular/intraparenchymal hematoma 5 cm or larger; and/or a parenchymal laceration deeper than 3 cm.	High-grade injury (WSES moderate, grade III): nonoperative management still attempted in stable patients, but splenic angioembolization is used liberally - grade III carries the highest embolization rate. Operative management for instability, peritonitis, or NOM failure.	Higher-risk tier: NOM failure and the need for intervention rise with grade; grade III had the highest angioembolization rate (~39%) in the WSES validation cohort.	okfonte Grade III = angioembolization candidate / highest AE rate (~38.9%) per WSES PMC6580626; embolization recommended grade III and above per StatPearls NBK441993.
IV	Grade IV Any injury accompanied by a splenic vascular injury (pseudoaneurysm or arteriovenous fistula) or active bleeding that remains confined within the splenic capsule; or a parenchymal laceration involving segmental or hilar vessels that produces more than 25% devascularization of the spleen.	High-grade injury (WSES severe, grades IV-V): operative management predominates - in stable patients NOM with angioembolization may be tried at high-acuity centers, but most undergo surgery (splenectomy). Unstable patients go directly to laparotomy.	High-risk tier: AAST grade greater than III had ~77% operative-management rate in the WSES cohort; grade and hemodynamic instability drive higher NOM failure and mortality.	okfonte AAST greater-than-III ~77.1% operative rate per WSES PMC6580626; high-grade = surgery-predominant per StatPearls NBK441993.
V	Grade V Any injury with a splenic vascular injury where active bleeding extends beyond the spleen into the peritoneum; or a shattered spleen.	High-grade injury (WSES severe, grades IV-V): operative management (usually total splenectomy) is the rule, particularly with hemodynamic instability or a shattered spleen; damage-control surgery for the unstable patient. Highly selected stable grade V may attempt NOM with embolization at major trauma centers.	Highest-risk tier: grade V is an independent predictor of NOM failure and mortality; the great majority require operative management.	okfonte Grade V predicts NOM failure/mortality and operative management per WSES PMC6580626 and StatPearls NBK441993; high-grade operative predominance (~77% for AAST greater-than-III).

Histórico de versões

Data	Evento	Detalhe	Situação
2018-01-01	revised	AAST organ injury scales updated (2018).	confirmado

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