Thursday, February 28, 2019

Splenic injury grading

Q: The American Association for the Surgery of Trauma (AAST) has a spleen injury grading scale based upon all of the following except

A) Imaging (CT) criteria 
B) Operative criteria
C) Pathologic criteria 
D) Clinical criteria

Answer: D

The objective of above question is to emphasize that splenic injury graded on the basis of CT is not always concordant with the grade of injury identified in the operating room.

The AAST imaging criteria for splenic injury are graded up to 5 levels and are different on the basis of
  • CT findings criteria
  • Operative criteria
  • Pathologic criteria



1. Cohn SM, Arango JI, Myers JG, et al. Computed tomography grading systems poorly predict the need for intervention after spleen and liver injuries. Am Surg 2009; 75:133. 

2.  Sutyak JP, Chiu WC, D'Amelio LF, et al. Computed tomography is inaccurate in estimating the severity of adult splenic injury. J Trauma 1995; 39:514. 

3.  Becker CD, Spring P, Glättli A, Schweizer W. Blunt splenic trauma in adults: can CT findings be used to determine the need for surgery? AJR Am J Roentgenol 1994; 162:343.

4.  Kohn JS, Clark DE, Isler RJ, Pope CF. Is computed tomographic grading of splenic injury useful in the nonsurgical management of blunt trauma? J Trauma 1994; 36:385. 

5.  Marmery H, Shanmuganathan K, Alexander MT, Mirvis SE. Optimization of selection for nonoperative management of blunt splenic injury: comparison of MDCT grading systems. AJR Am J Roentgenol 2007; 189:1421.

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