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e-CASES: Spleen : AAST organ injury scale

Dr Antoine Micheau , CHU Arnaud de Villeneuve , Montpellier , Herault , France

AAST organ injury scale for splenic injuries


Grade I

Hematoma :Subcapsular, nonexpanding, <10% surface area

Laceration: Capsular tear, nonbleeding, <1cm parenchymal depth


Grade II

Hematoma: Subcapsular, nonexpanding, 10-50% surface area - Intraparenchymal, <10 cm diameter, nonexpanding

Laceration: Capsular tear, 1-3 cm parenchymal depth, <10 cm length


Grade III

Hematoma: Subcapsular, >50% surface area or expanding - Ruptured subcapsular or parenchymal hematoma - Intraparenchymal hematoma >10 cm or expanding

Laceration : > 3 cm parenchymal depth


Grade IV

Laceration: Parenchymal disruption involving 25-75% of hepatic lobe or 1-3 Couinaud’s segments within a single lobe


Grade V

Laceration: Parenchymal disruption involving >75% of hepatic lobe or >3 Couinaud’s segments within single lobe


Vascular: Juxtahepatic venous injuries; i.e., retrohepatic vena cava/central major hepatic veins - Hepatic avulsion

! Advance one grade for multiple injuries to same organ up to grade III