Splenic Laceration Grading Calculator

How does this Splenic laceration grading calculator work?

This is a health tool that aims to provide clinicians with a quick mean to assess the splenic injury presentation, whether it is caused by blunt or penetrative trauma. It is according to the American Association for the Surgery of Trauma (AAST) splenic injury grading system and comprises of the five gradings as explained below:

Grade I

■ Subcapsular haematoma <10% of surface area;

■ Capsular laceration <1 cm depth.

Grade II

■ Subcapsular haematoma 10-50% of surface area;

■ Intraparenchymal haematoma <5 cm in diameter;

■ Laceration 1-3 cm depth not involving trabecular vessels.

Grade III

■ Subcapsular haematoma >50% of surface area or expanding;

■ Intraparenchymal haematoma >5 cm or expanding;

■ Laceration >3 cm depth or involving trabecular vessels;

■ Ruptured subcapsular or parenchymal haematoma.

Grade IV

■ Laceration involving segmental or hilar vessels with major devascularisation (>25% of spleen).

Grade V

■ Shattered spleen;

■ Hilar vascular injury with devascularised spleen.

As a rule of thumb, lower grade injuries, grades I to III can be managed non operatively in most cases while the two higher grades might require either an angioembolisation or splenectomy.

Clinical presentation does not differ much in patients, with most of them accusing pain and tenderness in the left upper abdominal quadrant, diffuse abdominal pain and rebound tenderness. In some cases, pain can irradiate towards the left shoulder due to nerve irritation. CT can display intraperitoneal blood and in case the bleeding exceeds 400- 500 mL, signs of shock will accompany.

The Splenic laceration grading calculator provides the injury grade which is then used alongside with the severity of other injuries in planning the intraoperative management and whether there is need for a transfusion protocol to be put in place as well. The grading depends on the extent and depth of the splenic hematoma and the existence or not of a laceration and if yes, in what dimensions.

The spleen is one of the most commonly injured organs in the abdomen alongside the liver, it is placed in the left upper quadrant under the 9^th to 12^th pairs of ribs. Its main functions include the filtration of red blood cells and immune system protection. This is why a conservationist treatment is always advised as after a splenectomy, the body loses these functions and becomes susceptible to a series of conditions.

Computed tomography is the most used non invasive exploratory mean to observe the spleen and any trauma. The most frequent findings include:

■ hematoma occurs in 47%;

■ laceration incidence is 47%;

■ rupture occurs in 33.3% of cases.

A new risk factor in spleen trauma is colonoscopy as there have been increasing reports of damage to the spleen following such a procedure. Another risk factor includes a preexisting injury or illness such as hematologic abnormalities leading to acute enlargement of the spleen with a thinning of the capsule.

Most common causes of blunt trauma include:

■ Motor vehicle accidents;

■ Bicycle accidents;

■ Domestic violence;

■ Contact sports.

Splenic injury is most observed in blunt trauma. Blunt splenic trauma management is similar to other types of organ trauma, starting with ensuring the airway is clear as well as circulation not impaired. Patients are then checked for vitals and seen whether they are hemodynamically stable or not and whether there is any profuse bleeding and if so, which is the cause. In the last case, exploratory abdominal surgery might be required.

References

1) Madoff DC, Denys A, Wallace MJ, Murthy R, Gupta S, Pillsbury EP, Ahrar K, Bessoud B, Hicks ME. Splenic arterial interventions: anatomy, indications, technical considerations, and potential complications. Radiographics. 2005 Oct;25 Suppl 1:S191-211.

2) Harbrecht BG1, Zenati MS, Ochoa JB, Townsend RN, Puyana JC, Wilson MA, Peitzman AB. (2004) Management of adult blunt splenic injuries: comparison between level I and level II trauma centers. J Am Coll Surg; 198(2):232-9.

3) Hettema M, Wolt S, van der Neut FW. (2014) Splenic injury as a complication of colonoscopy. Ned Tijdschr Geneeskd. 2014;158:A8006.