Pancreatic injuries are graded I-V with increasing severity having higher grading.

• Grade I:
• Pancreatic minor contusion without ductal injury
• Pancreatic superficial laceration without duct injury
• Grade II:
• Pancreatic major contusion without ductal injury or tissue loss
• Pancreatic major laceration without ductal injury or tissue loss
• Grade III:
• Pancreatic laceration with distal transection or parenchymal injury with ductal injury
• Grade IV:
• Pancreatic laceration with proximal transection or parenchymal injury involving the ampulla
• Grade V:
• Pancreatic laceration with massive disruption of the pancreatic head

Note to advance one grade for multiple injuries up to grade III.

Proximal pancreas is defined as "to the patients' right of the superior mesenteric vein."

Reference:

Moore EE, Cogbill TH, Malangoni MA, et al. Organ injury scaling, II: Pancreas, duodenum, small bowel, colon, and rectum. J Trauma. 1990;30(11):1427-9.