# AAST Spleen — AAST splenic injury scale

> Grades splenic injury severity on CT.

**Situação:** vigente · **Órgão:** Baço · **Órgão emissor:** American Association for the Surgery of Trauma · **Versão:** 2018 · **Ano:** 2018

## Procedência e vigência
- Família: léxico
- Tipo de lógica: flat
- Modalidade: CT
- Fonte primária: Kozar RA, Crandall M, Shanmuganathan K, et al.. Organ injury scaling 2018 update: spleen, liver, and kidney (AAST) (2018) — https://doi.org/10.1097/TA.0000000000002058
- Última verificação: 2026-06-26
- Última checagem: 2026-06-26

## Categorias

| Código | Rótulo | Critérios | Conduta | Risco | Localizador | Verificado |
| --- | --- | --- | --- | --- | --- | --- |
| 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%. | 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. | 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. | 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. | 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. | 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). | ✓ |

### Citações por categoria
- **I**: Kozar RA, Crandall M, Shanmuganathan K, et al.. Organ injury scaling 2018 update: spleen, liver, and kidney (AAST) (2018) — https://doi.org/10.1097/TA.0000000000002058 · 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**: Kozar RA, Crandall M, Shanmuganathan K, et al.. Organ injury scaling 2018 update: spleen, liver, and kidney (AAST) (2018) — https://doi.org/10.1097/TA.0000000000002058 · Low-grade NOM/embolization grouping per WSES PMC6580626 and StatPearls NBK441993; ~20% NOM failure with blush per EAST multicenter study PMC10921525.
- **III**: Kozar RA, Crandall M, Shanmuganathan K, et al.. Organ injury scaling 2018 update: spleen, liver, and kidney (AAST) (2018) — https://doi.org/10.1097/TA.0000000000002058 · Grade III = angioembolization candidate / highest AE rate (~38.9%) per WSES PMC6580626; embolization recommended grade III and above per StatPearls NBK441993.
- **IV**: Kozar RA, Crandall M, Shanmuganathan K, et al.. Organ injury scaling 2018 update: spleen, liver, and kidney (AAST) (2018) — https://doi.org/10.1097/TA.0000000000002058 · AAST greater-than-III ~77.1% operative rate per WSES PMC6580626; high-grade = surgery-predominant per StatPearls NBK441993.
- **V**: Kozar RA, Crandall M, Shanmuganathan K, et al.. Organ injury scaling 2018 update: spleen, liver, and kidney (AAST) (2018) — https://doi.org/10.1097/TA.0000000000002058 · 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). | 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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