The spleen is the most commonly injured solid organ in abdominal trauma. Below, is the traditional grading system as described by Moore et al, from the Journal of Trauma 1995 - Organ Injury Scaling: Spleen & Liver (Published almost exactly 17 years ago this month!).
In the haemodynamically unstable patient (noting associated injuries), with a splenic injury, the decision is simple, - embolization or laparotomy & splenctomy. But what about the rest? Can the traditional grading system accurately predict where non-operative management is likely to be successful?
Typically, grade 1-3 injuries are managed non-operatively, whilst grade 4 and above are managed operatively.
The problem with this grading system, is that it doesn't take into acount the appearance of contrast extravasation on CT, which leads to a higher rate of failed non-operative management. It also tends to underestimate the extent of injury.
In a study published online in the European Journal of Trauma and Emergency Surgery, the authors conducted a retrospective study to compare the accuracy of traditional CT grading with pathological findings :