Splenic injury-trauma grading
Splenic injuries are graded I-V, with increasing severity having higher grading.
Splenectomy is typically reserved for hemodynamically unstable patients, regardless of grade of laceration.
- Splenic subcapsular hematoma (nonexpanding) of <10% surface area
- Splenic laceration/Capsular tear <1cm depth
- Splenic subcapsular hematoma (nonexpanding) of 10-50% surface area
- Intraparenchymal hematoma <5cm diameter
- Splenic laceration 1-3 cm deep without vascular involvement
- Splenic subcapsular hematoma >50% surface area or expanding and ruptured subcapsular or parenchymal hematoma
- Intraparenchymal hematoma >5 cm or expanding
- Splenic laceration >3 cm deep or involving trabecular vessels
- Splenic laceration involving the segmental/hilar vessels with devascularization of >25% of the spleen
- Splenic laceration with shattered spleen
- Vascular injury that involves total splenic devascularization (hilar vascular injury)
Note that one grade increase is indicated for multiple injuries to the spleen up to a grade of III.
Moore EE, et al. Organ injury scaling: spleen and liver (1994 revision). J Trauma. 1995;38:323-4.
Trauma scoring. Trauma.org. Available at http://www.trauma.org/archive/scores/ois-spleen.html (Accessed 23 April 2008)