Am. Assoc. For Surgery of Trauma (AAST) Grading

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RECTUM SPLEEN LIVER PANCREAS KIDNEY BLADDER SMALL BOWEL STOMACH

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

RECTUM

Grade I

Hematoma

Contusion or hematoma without devascularization

Laceration

Partial thickness, no perforation

Grade II

Laceration

<50% of circumference

Grade III

Laceration

>50% of circumference without transection

Grade IV

Laceration

Full-thickness laceration with extension into the perineum

Grade V

Vascular

Devascularized segment


SPLEEN

Grade I

Hematoma

Subcapsular: <10% surface area

Laceration

Capsular tear: <1 cm parenchymal depth

Grade II

Hematoma

Subcapsular: 10-50% surface area

Intraparenchymal: <5 cm diameter

Laceration

Capsular tear: 1-3cm parenchymal depth not involving a parenchymal vessel

Grade III

Hematoma

Subcapsular of greater than 50% of surface area or expanding and ruptured subcapsular or parenchymal hematoma

Intraparenchymal > 5 cm or expanding

Laceration

> 3 cm in depth or involving trabecular vessels

Grade IV

Hematoma

Subcapsular: >50% surface area or expanding

Intraparenchymal: >5 cm diameter

Ruptured subcapsular or parenchymal hematoma

Laceration

>3 cm parenchymal depth or involving trabecular vessels

Grade V

Completely shattered spleen

Hilar vascular injury with devascularized spleen


LIVER

Grade I

Hematoma

Subcapsular: <10% surface area

Laceration

Capsular tear: <1 cm parenchymal depth

Grade II

Hematoma

Subcapsular: 10-50% surface area

Intraparenchymal: <10 cm diameter

Laceration

1-3 cm parenchymal depth, <10 cm length

Grade III

Hematoma

Subcapsular: >50% surface area or expanding. Ruptured subcapsular or parenchymal hematoma

Intraparenchymal: >10 cm diameter or expanding

Laceration

>3 cm parenchymal depth

Grade IV

Laceration

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

Grade V

Laceration

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

Vascular

Juxtahepatic venous injuries i.e. retrohepatic vena cava/central major hepatic veins

Grade VI

Vascular

Hepatic avulsion


PANCREAS

Grade I

Hematoma

Minor contusion without duct injury

Laceration

Superficial laceration without duct injury

Grade II

Hematoma

Major contusion without duct injury or tissue loss

Laceration

Major laceration without duct injury or tissue loss

Grade III

Laceration

Distal transection or parenchymal injury with duct injury

Grade IV

Laceration

Proximal transection or parenchymal injury involving ampulla

Proximal pancreas: to the right of the superior mesenteric vein

Grade V

Laceration

Massive disruption of pancreatic head


KIDNEY

Grade I

Contusion

Microscopic or gross hematuria, urological studies normal

Hematoma

Subcapsular, nonexpanding without parenchymal laceration

Grade II

Hematoma

Nonexpanding perirenal hematoma confined to renal retroperitoneum

Laceration

<1 cm parenchymal depth of renal cortex without urinary extravasation

Grade III

Laceration

1 cm depth of renal cortex, without collecting system rupture or urinary extravasation

Grade IV

Laceration

Parenchymal laceration extending through the renal cortex, medulla and collecting system

Vascular

Main renal artery or vein injury with contained hemorrhage

Grade V

Laceration

Completely shattered kidney

Vascular

Avulsion of renal hilum which devascularizes kidney


BLADDER

Grade I

Hematoma

Contusion, intramural hematoma

Laceration

Partial thickness

Grade II

Laceration

Extraperitoneal bladder wall laceration <2 cm

Grade III

Laceration

Extraperitoneal (>2cm) or intraperitoneal (<2cm) bladder wall laceration

Grade IV

Laceration

Intraperitoneal bladder wall laceration >2cm

Grade V

Vascular

Intraperitoneal or extraperitoneal bladder wall laceration extending into the bladder neck or ureteral orifice (trigone)


SMALL BOWEL

Grade I

Hematoma

Contusion or hematoma without devascularization

Laceration

Partial thickness, no perforation

Grade II

Laceration

<50% of circumference

Grade III

Laceration

>50% of circumference without transection

Grade IV

Laceration

Transection of the small bowel +/- segmental tissue loss

Grade V

Vascular

Devascularized segment


STOMACH

Grade I

Hematoma

Contusion or hematoma without devascularization

Laceration

Partial thickness, no perforation

Grade II

Laceration

<2 cm in GE junction or pylorus

<5 cm in proximal 1/3 stomach

<10 cm in distal 2/3 stomach

Grade III

Laceration

>2 cm in GE junction or pylorus

>5 cm in proximal 1/3 stomach

>10 cm in distal 2/3 stomach

Grade IV

Vascular

Tissue loss or devascularization <2/3 stomach

Grade V

Vascular

Tissue loss or devascularization >2/3 stomach