The AAST (American Association for the Surgery of Trauma) Organ Injury Scale for splenic laceration grades from I–V. Which grade specifically requires splenectomy as the definitive treatment in hemodynamically unstable patients according to the scale description?

• A Grade V — shattered spleen or hilar vascular injury with complete devascularization ✓
• B Grade II — laceration 1–3 cm parenchymal depth, no trabecular vessel involvement
• C Grade III — laceration >3 cm depth or trabecular vessel involvement
• D Grade IV — laceration involving segmental or hilar vessels with >25% devascularization

Explanation

AAST Grade V splenic injury describes a shattered spleen or hilar vascular injury producing complete devascularization. In hemodynamically unstable patients, Grade V injuries require emergency splenectomy. Grade IV injuries (hilar, >25% devascularization) in unstable patients also frequently require splenectomy or angioembolization. Grades I–III can often be managed non-operatively with angioembolization in hemodynamically stable patients. The trend in modern trauma surgery is toward non-operative management (NOM) with selective embolization for grades III–IV in stable patients.

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

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