AAST solid organ injury (2018)

AAST 2018CTTrauma

2018 revision incorporates CT vascular injury findings. Vascular injury = pseudoaneurysm or AV fistula; active bleeding = contrast extravasation increasing in delayed phase. Advance one grade for multiple injuries up to grade III.

Spleen

Grade	Findings
I	Subcapsular hematoma <10% surface area · laceration <1 cm depth · capsular tear
II	Subcapsular hematoma 10–50% surface area · intraparenchymal hematoma <5 cm · laceration 1–3 cm depth
III	Subcapsular hematoma >50% or ruptured · intraparenchymal hematoma ≥5 cm · laceration >3 cm depth
IV	Any injury with splenic vascular injury or active bleeding confined within splenic capsule · laceration of segmental/hilar vessels with >25% devascularization
V	Shattered spleen · any injury with splenic vascular injury and active bleeding extending beyond the spleen into the peritoneum

Liver

Grade	Findings
I	Subcapsular hematoma <10% surface area · laceration <1 cm depth · capsular tear
II	Subcapsular hematoma 10–50% surface area · intraparenchymal hematoma <10 cm · laceration 1–3 cm depth and ≤10 cm length
III	Subcapsular hematoma >50% or ruptured with active bleeding · intraparenchymal hematoma >10 cm · laceration >3 cm depth · any vascular injury or active bleeding contained within liver parenchyma
IV	Parenchymal disruption 25–75% of a hepatic lobe · active bleeding extending beyond the liver into the peritoneum
V	Parenchymal disruption >75% of a hepatic lobe · juxtahepatic venous injury (retrohepatic IVC, central major hepatic veins)

Kidney

Grade	Findings
I	Subcapsular hematoma and/or contusion without laceration
II	Perirenal hematoma confined to Gerota fascia · laceration ≤1 cm without urinary extravasation
III	Laceration >1 cm without collecting system rupture or urinary extravasation · any vascular injury or active bleeding contained within Gerota fascia
IV	Laceration into collecting system with urinary extravasation · renal pelvis laceration and/or complete UPJ disruption · segmental artery or vein injury · active bleeding beyond Gerota fascia · segmental or complete infarction from vessel thrombosis without active bleeding
V	Main renal artery or vein laceration or hilar avulsion · devascularized kidney with active bleeding · shattered kidney with loss of identifiable parenchymal anatomy

Sources

Kozar RA, Crandall M, Shanmuganathan K, et al. Organ injury scaling 2018 update: spleen, liver, and kidney. J Trauma Acute Care Surg. 2018;85:1119–1122.PubMed ↗

Radessential summarizes published classification systems for practicing radiologists. Summaries are condensed; confirm details against the cited source before relying on them for patient care.