The EAST (Eastern Association for the Surgery of Trauma) guidelines and AAST Organ Injury Scale grade for splenic injuries: a Grade IV splenic injury involves which finding?

• A Capsular laceration <1 cm parenchymal depth
• B Parenchymal laceration 3–10 cm depth not involving trabecular vessels
• C Laceration involving segmental or hilar vessels with devascularization >25% of spleen ✓
• D Complete splenic fragmentation or hilar injury with total devascularization

Explanation

The AAST splenic organ injury scale: Grade I = capsular tear <1 cm; Grade II = laceration 1–3 cm not involving trabecular vessels; Grade III = >3 cm laceration or involvement of trabecular vessels; Grade IV = laceration involving segmental or hilar vessels producing devascularization >25% of spleen; Grade V = complete shatter or hilar vascular injury with total devascularization. Grade IV injuries often require intervention (embolization or splenectomy) as non-operative management failure rates are high.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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