Trauma - Injury Grade Scale
Spleen Injury |
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| Grade | Description | Severity Coding |
| General | Most commonly injured abdominal organ in children. Findings include LUQ pain, left shoulder pain (Kehr’s sign), abdominal distension, and LUQ ecchymosis or abrasions. | |
| I | Subcapsular hematoma <10% surface area. Capsular tear or parenchymal laceration <1 cm depth. | Minor |
| II | Subcapsular hematoma 10–50%. Intraparenchymal hematoma <5 cm. Laceration 1–3 cm depth without trabecular vessel involvement. | Moderate |
| III | Subcapsular hematoma >50% or expanding. Ruptured subcapsular or parenchymal hematoma. Intraparenchymal hematoma >5 cm or expanding. Laceration >3 cm depth. | Major |
| IV | Subcapsular hematoma >50% or expanding. Ruptured subcapsular or parenchymal hematoma. Intraparenchymal hematoma >5 cm or expanding. Laceration >3 cm depth. | Major |
| V | Subcapsular hematoma >50% or expanding. Ruptured subcapsular or parenchymal hematoma. Intraparenchymal hematoma >5 cm or expanding. Laceration >3 cm depth. | Massive |
Liver Injury |
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| Grade | Description |
| General | Subcapsular hematoma >50% or expanding. Ruptured subcapsular or parenchymal hematoma. Intraparenchymal hematoma >5 cm or expanding. Laceration >3 cm depth. |
| I | Subcapsular hematoma <10%. Capsular tear or parenchymal laceration <1 cm depth. |
| II | Subcapsular hematoma 10–50%. Intraparenchymal hematoma <10 cm diameter. Laceration <3 cm depth and <10 cm length. |
| III | Subcapsular hematoma >50%. Ruptured subcapsular or parenchymal hematoma. Intraparenchymal hematoma with active bleeding. Laceration >3 cm depth or >10 cm length. Vascular injury with bleeding contained within parenchyma. |
| IV | Parenchymal disruption involving 25–75% of hepatic lobe. Active bleeding extending into peritoneum. |
| V | Parenchymal disruption >75% of hepatic lobe. Juxtahepatic venous injury including retrohepatic vena cava or major hepatic veins. |
Pancreas Injury |
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| Grade | Description |
| General | Fourth most commonly injured abdominal organ in children. Injury rate approximately 0.6%, most often due to blunt trauma |
| I | Minor contusion without duct injury. Superficial laceration without duct injury. |
| II | Major contusion without duct injury or tissue loss. Major laceration without duct injury or tissue loss. |
| III | Distal transection or parenchymal injury with duct injury. |
| IV | Proximal transection or parenchymal injury involving ampulla. |
| V | Massive disruption of pancreatic head. |
Kidney Injury |
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| Grade | Description |
| I | Subcapsular hematoma or parenchymal contusion without laceration. Non expanding subcapsular hematoma. |
| II | Perirenal non expanding hematoma confined to Gerota fascia. Parenchymal laceration <1 cm depth without urinary extravasation |
| III | Parenchymal laceration >1 cm depth without collecting system rupture or urinary extravasation. Vascular injury or bleeding contained within Gerota fascia. |
| IV | Laceration extending into collecting system with urinary extravasation. Renal pelvis laceration or complete UPJ disruption. Segmental renal vessel injury. Active bleeding beyond Gerota fascia. Segmental or complete renal infarction without active bleeding |
| V | Main renal artery or vein laceration. Hilar avulsion. Devascularized or shattered kidney with loss of identifiable parenchyma. |
These pathways do not establish a standard of care to be followed in every case. It is recognized that each case is different, and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare a pathway for each. Accordingly, these pathways should guide care with the understanding that departures from them may be required at times.