Pathway for Blunt Abdominal Solid Organ Injury

Determine Grade

SPLENIC INJURY
Grade I Hematoma: Subcapsular < 10% of surface area
Laceration: Capsular < 1 cm depth
Grade II Hematoma: Subcapsular 10 - 50% of surface area
Hematoma: Intraparenchymal < 5 cm in diameter
Laceration: 1 - 3 cm depth not involving trabecular vessels
Grade III Hematoma: Subcapsular > 50% of surface area or expanding
Hematoma: Intraparenchymal > 5 cm or expanding
Laceration: > 3 cm depth or involving trabecular vessels
Hematoma: Ruptured subcapsular or parenchymal
Grade IV Laceration: Involving segmental or hilar vessels with major devascularization
(> 25% of spleen)
Grade V Shattered spleen:Hilar vascular injury with devascularized spleen

LIVER INJURY
Grade I Hematoma: Sub capsular, < 10% surface area
Laceration: Capsular tear, < 1 cm depth
Grade II Hematoma: Sub capsular, 10 - 50% surface area
Hematoma: Intraparenchymal < 10 cm diameter
Laceration: Capsular tear, 1 - 3 cm depth, < 10 cm length
Grade III Hematoma: Sub capsular, > 50% surface area, or ruptured with active bleeding
Hematoma: Intraparenchymal > 10 cm diameter
Laceration: Capsular tear, > 3 cm depth
Grade IV Hematoma: Ruptured intraparenchymal with active bleeding
Laceration: Parenchymal distruption involving 25 - 75% hepatic lobes or 1 - 3 Couinaud segments (within one lobe)
Grade V Laceration: Parenchymal distruption involving > 75% helpatic lobe or > 3 Couinaud segments (within one lobe)
Vascular: Juxtahepatic venous injuries (IVC, major hepatic vein)
Grade VI Hepatic avulsion

RENAL INJURY*
Grade I Hematoma: Contusion or non-enlarging subcapsular hematoma
Laceration: None
Grade II Hematoma: Non-expanding peri-renal hematoma
Laceration: Superfical, < 1 cm depth and does not involve the collecting system
Grade III Laceration: > 1 cm, without extension into the renal pelvis or collecting system and with no evidence of urine extravasation
Grade IV Laceration: Extends to renal pelvis or urinary extravasation
Grade V Shattered kidney: devascularization of kidney due to hilar injury

*According to depth of damage and involvement of the urinary collecting system and renal vessels