The Organ Injury Scale (OIS) of the American Association for the Surgery of Trauma (AAST) grades splenic injury from I to V. A Grade IV splenic laceration involves:

• A Subcapsular haematoma <10% surface area
• B Laceration >3 cm parenchymal depth or involving trabecular vessels
• C Shattered spleen or hilar vascular injury causing total devascularisation
• D Laceration involving segmental or hilar vessels with >25% devascularisation ✓

Explanation

AAST OIS splenic grading: Grade I — subcapsular haematoma <10%; Grade II — haematoma 10–50% or laceration 1–3 cm depth; Grade III — haematoma >50%/expanding or laceration >3 cm or involving trabecular vessels; Grade IV — laceration involving segmental/hilar vessels with >25% devascularisation; Grade V — shattered spleen or hilar avulsion. Grades I–III are managed non-operatively in haemodynamically stable patients; IV–V often require intervention.

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

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