Abstract
The American Association for the Surgery of Trauma (AAST) Organ Injury Scale (OIS) has been widely used for blunt traumatic injuries of the liver, spleen, and kidney since 1989 to stratify patients’ injury severity, guide treatment management, and assist clinical research. This article aims to present the radiological findings of blunt traumatic injuries of the liver, spleen, and kidney and to explain the grading of injuries of these organs according to the imaging heading of the AAST-OIS 2018 revised version.
Keywords: Abdominal injuries, diagnostic imaging, injury severity score
References
Moore EE, Shackford SR, Pachter HL, McAninch JW, Browner BD, Champion HR, et al. Organ injury scaling: spleen, liver, and kidney. J Trauma. 1989; 29: 1664-6.
Moore EE, Cogbill TH, Jurkovich GJ, Shackford SR, Malangoni MA, Champion HR. Organ injury scaling: spleen and liver (1994 revision). J Trauma. 1995; 38: 323-4.
Kozar RA, Crandall M, Shanmuganathan K, Zarzaur BL, Coburn M, Cribari C, et al. Organ injury scaling 2018 update: spleen, liver, and kidney. J Trauma Acute Care Surg. 2018; 85: 1119-22.
Coccolini F, Coimbra R, Ordonez C, Kluger Y, Vega F, Moore EE, et al. Liver trauma: WSES 2020 guidelines. World J Emerg Surg. 2020; 15: 24.
Soto JA, Anderson SW. Multidetector CT of blunt abdominal trauma. Radiology. 2012; 265: 678-93.
Graves JA, Hanna TN, Herr KD. Pearls and pitfalls of hepatobiliary and splenic trauma: what every trauma radiologist needs to know. Emerg Radiol. 2017; 24: 557-68.
Robinson JD, Sandstrom CK, Lehnert BE, Gross JA. Imaging of blunt abdominal solid organ trauma. Semin Roentgenol. 2016; 51: 215-29.
Roberts JL, Dalen K, Bosanko CM, Jafir SZ. CT in abdominal and pelvic trauma. Radiographics. 1993; 13: 735-52.
Orwig D, Federle MP. Localized clotted blood as evidence of visceral trauma on CT: the sentinel clot sign. AJR Am J Roentgenol. 1989; 153: 747-9.
Hemachandran N, Gamanagatti S, Sharma R, Shanmuganathan K, Kumar A, Gupta A, et al. Revised AAST scale for splenic injury (2018): does addition of arterial phase on CT have an impact on the grade? Emerg Radiol. 2021; 28: 47-54.
Boscak AR, Shanmuganathan K, Mirvis SE, Fleiter TR, Miller LA, Sliker CW, et al. Optimizing trauma multidetector CT protocol for blunt splenic injury: need for arterial and portal venous phase scans. Radiology. 2013; 268: 79-88.
Uyeda JW, LeBedis CA, Penn DR, Soto JA, Anderson SW. Active hemorrhage and vascular injuries in splenic trauma: utility of the arterial phase in multidetector CT. Radiology. 2014; 270: 99-106.
Dixe de Oliveira Santo I, Sailer A, Solomon N, Borse R, Cavallo J, Teitelbaum J, et al. Grading abdominal trauma: changes in and Implications of the revised 2018 AAST-OIS for the spleen, liver, and kidney. RadioGraphics. 2023; 43: e230040.
Shanmuganathan K, Mirvis SE, Boyd-Kranis R, Takada T, Scalea TM. Nonsurgical management of blunt splenic injury: use of CT criteria to select patients for splenic arteriography and potential endovascular therapy. Radiology. 2000; 217: 75-82.
Gayer G, Zissin R, Apter S, Garniek A, Ramon J, Kots E, et al. Urinomas caused by ureteral injuries: CT appearance. Abdom Imaging. 2002; 27: 88-92.
Jeavons C, Hacking C, Beenen LF, Gunn ML. A review of split-bolus single-pass CT in the assessment of trauma patients. Emerg Radiol. 2018; 25: 367-74.
Renzulli P, Gross T, Schnüriger B, Schoepfer AM, Inderbitzin D, Exadaktylos AK, et al. Management of blunt injuries to the spleen. Br J Surg. 2010; 97: 1696-703.
Patel N, Alarcon L. Blunt splenic trauma. The American Association for the Surgery of Trauma. 2012. Erişim linki: https://www.aast.org/resources-detail/8764001f-b3b2-425e-89c5- 5284d417de1e.
Marmery H, Shanmuganathan K, Mirvis SE, Richard H 3rd, Sliker C, Miller LA, et al. Correlation of multidetector CT findings with splenic arteriography and surgery: prospective study in 392 patients. J Am Coll Surg. 2008; 206: 685-93.
Unal E, Onur MR, Akpinar E, Ahmadov J, Karcaaltincaba M, Ozmen MN, et al. Imaging findings of splenic emergencies: a pictorial review. Insights Imaging. 2016; 7: 215-22.
Jin W, Deng L, Lv H, Zhang Q, Zhu J. Mechanisms of blunt liver trauma patterns: an analysis of 53 cases. Exp Ther Med. 2013; 5: 395-98.
Yoon W, Jeong YY, Kim JK, Seo JJ, Lim HS, Shin SS, et al. CT in blunt liver trauma. RadioGraphics. 2005; 25: 87-104.
Patten RM, Spear RP, Vincent LM, Hesla RB, Jurkovich GJ. Traumatic laceration of the liver limited to the bare area: CT findings in 25 patients. AJR Am J Roentgenol. 1993; 160: 1019-22.
Willmann JK, Roos JE, Platz A, Pfammatter T, Hilfiker PR, Marincek B, et al. Multidetector CT: detection of active hemorrhage in patients with blunt abdominal trauma. AJR Am J Roentgenol. 2002; 179: 437-44.
Gupta A, Stuhlfaut JW, Fleming KW, Lucey BC, Soto JA. Blunt trauma of the pancreas and biliary tract: a multimodality imaging approach to diagnosis. Radiographics. 2004; 24: 1381-95.
Melamud K, LeBedis CA, Anderson SW, Soto JA. Biliary imaging: multimodality approach to imaging of biliary injuries and their complications. Radiographics. 2014; 34: 613-23.
Fleming KW, Lucey BC, Soto JA, Oates ME. Posttraumatic bile leaks: role of diagnostic imaging and impact on patient outcome. Emerg Radiol. 2006; 12: 103-7.
LeBedis CA, Anderson SW, Mercier G, Kussman S, Coleman SL, Golden L, et al. The utility of CT for predicting bile leaks in hepatic trauma. Emerg Radiol. 2015; 22: 101-7.
Coccolini F, Moore EE, Kluger Y, Biffl W, Leppaniemi A, et al. Kidney and uro-trauma: WSES-AAST guidelines. World J Emerg Surg. 2019; 14: 54.
Lee YJ, Oh SN, Rha SE, Byun JY. Renal trauma. Radiol Clin North Am. 2007; 45: 581-92.
Esho JO, Ireland GW, Cass AS. Renal trauma and preexisting lesions of the kidney. Urology. 1973; 1: 134-5.
Lynch TH, Martínez-Piñeiro L, Plas E, Serafetinides E, Türkeri L, Santucci RA, et al. EAU guidelines on urological trauma. Eur Urol. 2005; 47: 1-15.
Bonatti M, Lombardo F, Vezzali N, Zamboni G, Ferro F, Pernter P, et al. MDCT of blunt renal trauma: imaging findings and therapeutic implications. Insights Imaging. 2015; 6: 261-72.
Gross JA, Lehnert BE, Linnau KF, Voelzke BB, Sandstrom CK. Imaging of urinary system trauma. Radiol Clin North Am. 2015; 53: 773-88.
Kawashima A, Sandler CM, Corl FM, West OC, Tamm EP, Fishman EK, et al. Imaging of renal trauma: a comprehensive review. Radiographics. 2001; 21: 557-74.
Dugi DD, 3rd, Morey AF, Gupta A, Nuss GR, Sheu GL, Pruitt JH. American Association for the Surgery of Trauma grade 4 renal injury substratification into grades 4a (low risk) and 4b (high risk). J Urol. 2010; 183: 592-7.
Ortega SJ, Netto FS, Hamilton P, Chu P, Tien HC. CT scanning for diagnosing blunt ureteral and ureteropelvic junction injuries. BMC Urol. 2008; 8: 3.
Morey AF, Brandes S, Dugi DD 3rd, Armstrong JH, Breyer BN, Broghammer JA, et al. Urotrauma: AUA guideline. J Urol. 2014; 192: 327-35.
Hosein M, Paskar D, Kodama R, Ditkofsky N. Coming together: a review of the American Association for the Surgery of Trauma’s updated kidney injury scale to facilitate multidisciplinary management. AJR Am J Roentgenol. 2019; 213: 1091-9.
Malaeb F, Figler B, Wessells H, Voelzke B. Should blunt segmental vascular renal injuries be considered an American Association for the Surgery of Trauma grade 4 renal injury? J Trauma Acute Care Surg. 2014; 76: 484-7.
Buckley JC, McAninch JW. Revision of current American Association for the Surgery of Trauma renal injury grading system. J Trauma. 2011; 70: 35-7.
Nuss GR, Morey AF, Jenkins AC, Pruitt JH, Dugi DD 3rd, Morse B, et al. Radiographic predictors of need for angiographic embolization after traumatic renal injury. J Trauma. 2009; 67(3): 578-82; discussion 582.
