Blunt Abdominal Solid Organ Injury Clinical Pathway — Emergency Department, Inpatient and ICU
Blunt Abdominal Solid Organ Injury Clinical Pathway — Emergency Department, Inpatient and ICU
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) |
Renal Injury
According to depth of damage and involvement of the urinary collecting system and renal vessels.
| Grade I | Hematoma: Contusion or non-enlarging subcapsular hematoma Laceration: None |
|---|---|
| Grade II | Hematoma: Non-expanding peri-renal hematoma Laceration: Superficial, < 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 |