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  • Injury Scoring Scale

    Injury Scoring Scale

    A Resource for Trauma Care Professionals

    Also available in PDF: Injury Scoring Scales

    The AAST’s list of organ injury scaling tables originated in a set of papers that published in the Journal of Trauma. However, the AAST does not hold the copyright to this material. In order to reprint the liver injury scale, interested parties will need to submit a formal request to Wolters Kluwer, the journal’s publisher. To do so:

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    Table 1: Cervical Vascular Injury
    Table 2: Chest Wall Injury
    Table 3: Heart Injury
    Table 4: Lung Injury
    Table 5: Thoracic Vascular Injury
    Table 6: Diaphragm Injury
    Table 7: Spleen Injury
    Table 8: Liver Injury
    Table 9: Extrahepatic Billiary Tree Injury
    Table 10: Pancreas Injury
    Table 11: Esophagus Injury
    Table 12: Stomach Injury
    Table 13: Duodenum Injury
    Table 14: Small Bowel Injury
    Table 15: Colon Injury
    Table 16: Rectum Injury    		 Table 17: Abdominal Vascular Injury
    Table 18: Adrenal Organ Injury
    Table 19: Kidney Injury
    Table 20: Ureter Injury
    Table 21: Bladder Injury
    Table 22: Urethra Injury
    Table 23: Uterus (non-pregnant) Injury
    Table 24: Uterus (pregnant) Injury
    Table 25: Fallopian Tube Injury
    Table 26: Ovary Injury
    Table 27: Vagina Injury
    Table 28: Vulva Injury
    Table 29: Testis Injury
    Table 30: Scrotum Injury
    Table 31: Penis Injury
    Table 32: Peripheral Vascular Organ Injury
     
    Table 1

    Cervical vascular organ injury scale
    Grade Description of injury ICD-9 AIS-90
           
    I Thyroid vein 900.8  
      Common facial vein 900.8  
      External jugular vein 900.81 1-3
      Non-named arterial/venous branches 900.9  
    II External carotid arterial branches (ascending pharyngeal, superior thyroid, Ingual, facial maxillary, occipital, posterior auricular) 900.8  
      Thyrocervical trunk or primary branches    
      Internal jugular vein 900.8  
      External carotid artery 900.1 1-3
    III Subclavian vein 900.02 2-3
      Vertebral artery 901.3 3-4
      Common carotid artery 900.8 2-4
    IV Subclavian artery 900.01 3-5
      Internal carotid artery (extracranial) 901.1 3-4
    V   900.03 3-5
    *Increase one grade for multiple grade III or IV injuries involving more than 50% vessel circumference. Decrease one grade for less than 25% vessel circumference disruption for grade IV or V.

    From Moore et al. [1]; with permission.

     

    Table 2

    Chest wall injury scale*
    Grade Injury Type Description of Injury ICD-9 AIS-90
    I Contusion Any size 911.0/922.1 1
      Laceration Skin & subcutaneous 875.0 1
      Fracture < 3 ribs, closed; nondisplaced clavicle closed 807.01 1-2
          807/02  
          810.00/810.03 2
    II Laceration Skin, subcutaneous and muscle 875.1 1
      Fracture >3 adjacent ribs, closed 807.03/807.09 2-3
        Open or displaced clavicle 810.10/810.13 2
        Nondisplaced sternum, closed 807.2 2
        Scapular body, open or closed 811.00/811.18 2
    III Laceration Full thickness including pleural penetration 862.29 2
      Fracture Open or displaced sternum 807.2 2
        Flail sternum 807.3  
        Unilateral flail segment (<3 ribs) 807.4 3-4
     IV Laceration Avulsion of chest wall tissues with underlying rib fractures 807.10/807.19 4
        Unilateral flail chest (>3 ribs)    
      Fracture Bilateral flail chest (>3 ribs on both sides) 807.4 3-4
    V Fracture   807.4 5
    *This scale is confined to the chest wall alone and does not reflect associated internal or abdominal injuries. Therefore, further delineation of upper versus lower or anterior versus posterior chest wall was not considered, and a grade VI was warranted. Specifically, thoracic crush was not used as a descriptive term; instead, the geography and extent of fractures and soft tissue injury were used to define the grade. From Moore et al. [2]; with permission.

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    Table 3

    Heart injury scale
    Grade Description of injury ICD-9 AIS-90
    I Blunt cardiac injury with minor ECG abnormality (nonspecific ST or T wave changes, premature arterial or ventricular contraction or persistent sinus tachycardia) 861.01 3
      Blunt or penetrating pericardial wound with out cardiac injury, cardiac tamponade, or cardiac herniation    
    II Blunt cardiac injury with heart block (right or left bundle branch, left anterior fascicular, or atrioventricular) or ischemic changes (ST depression or T wave inversion) without cardiac failure 861.01 3
      Penetrating tangential myocardial wound up to, but not extending through endocardium, without tamponade 861.12 3
    III Blunt cardiac injury with sustained (>6 beats/min) or multilocal ventricular contractions 861.01 3-4
      Blunt or penetrating cardiac injury with septal rupture, pulmonary or tricuspid valvular incompetence, papillary muscle dysfunction, or distal coronary arterial occlusion without cardiac failure 861.01 3-4
      Blunt pericardial laceration with cardiac herniation    
      Blunt cardiac injury with cardiac failure    
    IV Penetrating tangential myocardial wound up to, but extending through, 861.01 3-4
      endocardium, with tamponade 861.12 3
      Blunt or penetrating cardiac injury with septal rupture, pulmonary or tricuspid    
      valvular incompetence, papillary muscle dysfunction, or distal coronary arterial 861.12 3
      occlusion producing cardiac failure    
      Blunt or penetrating cardiac injury with aortic mitral valve incompetence    
      Blunt or penetrating cardiac injury of the right ventricle, right atrium, or left atrium    
      Blunt or penetrating cardiac injury with proximal coronary arterial occlusion    
      Blunt or penetrating left ventricular perforation    
      Stellate wound with < 50% tissue loss of the right ventricle, right atrium, or of left atrium 861.03 5
    V Blunt avulsion of the heart; penetrating wound producing > 50% tissue loss of a chamber 861.03  
        861.13 5
        861.03 5
           
    VI   861.13 6
    *Advance one grade for multiple wounds to a single chamber or multiple chamber involvement.

    From Moore et al. [3]; with permission.

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    Table 4

    Lung Injury Scale
    Grade* Injury Type Description of Injury ICD-9 AIS-90
             
    I Contusion Unilateral, <1 lobe 861.12 3
          861.31  
    II Contusion Unilateral, single lobe 861.20 3
          861.30  
      Laceration Simple pneumothorax 860.0/1 3
    III Contusion Unilateral, > 1 lobe 861.20 3
          861.30  
      Laceration Persistent (> 72 hrs) air leak from distal airway 860.0/1 3-4
          860.4/5  
          862.0  
      Hematoma Nonexpanding intraparenchymal 861.30  
    IV Laceration Major (segmental or lobar) air leak 862.21 4-5
          861.31  
      Hematoma Expanding intraparenchymal    
      Vascular Primary branch intrapulmonary vessel disruption 901.40 3-5
             
    V Vascular Hilar vessel disruption 901.41 4
          901.42  
    VI Vascular Total uncontained transection of pulmonary hilum 901.41 4
          901.42  
             
    *Advance one grade for bilateral injuries up to grade III. Hemothorax is scored under thoracic vascular injury scale.

    From Moore et al. [3]; with permission.

    		  

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    Table 5

    Thoracic Vascular Injury Scale
    Grade* Description of injury ICD-9 AIS-90
           
    I Intercostal artery/vein 901.81 2-3
      Internal mammary artery/vein 901.82 2-3
      Bronchial artery/vein 901.89 2-3
      Esophageal artery/vein 901.9 2-3
      Hemizygous vein 901.89 2-3
      Unnamed artery/vein 901.9 2-3
    II Azygos vein 901.89 2-3
      Internal jugular vein 900.1 2-3
      Subclavian vein 901.3 3-4
      Innominate vein 901.3 3-4
    III Carotid artery 900.01 3-5
      Innominate artery 901.1 3-4
      Subclavian artery 901.1 3-4
    IV Thoracic aorta, descending 901.0 4-5
      Inferior vena cava (intrathoracic) 902.10 3-4
      Pulmonary artery, primary intraparenchymal branch 901.41 3
      Pulmonary vein, primary intraparenchymal branch 901.42 3
    V Thoracic aorta, ascending and arch 901.0 5
      Superior vena cava 901.2 3-4
      Pulmonary artery, main trunk 901.41 4
      Pulmonary vein, main trunk 901.42 4
    VI Uncontained total transection of 901.0 5
      thoracic aorta or pulmonary 901.41 4
      hilum 901.42  
    *Increase one grade for multiple grade III or IV injuries if more than 50% circumference; decrease one grade for grade IV injuries if less than 25% circumference.

    From Moore et al [3]; with permission

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    Table 6

    Diaphragm injury scale
    Grade* Description of injury ICD-9 AIS-90
           
    I Contusion 862.0 2
    II Laceration <2cm 862.1 3
    III Laceration 2-10cm 862.1 3
    IV Laceration >10 cm with tissue loss < 25 cm2 862.1 3
    V Laceration with tissue loss > 25 cm2 862.1 3
    *Advance one grade for bilateral injuries up to grade III.

    From Moore et al. [3]; with permission

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    Table 7

    Spleen Injury Scale (2018 revision)
    Grade* AIS Severity Imaging Criteria (CT Findings) Operative Criteria Pathologic Criteria
    I 2 Subcapsular hematoma <10% surface area  Subcapsular hematoma <10% surface area  Subcapsular hematoma <10% surface area 
        Parenchymal laceration <1 cm depth Parenchymal laceration <1 cm depth Parenchymal laceration <1 cm depth
        Capsular tear  Capsular tear  Capsular tear 
             
    II 2 Subcapsular hematoma 10-50% surface
    area; intraparenchymal hematoma <5 cm    		 Subcapsular hematoma 10-50% surface
    area; intraparenchymal hematoma <5 cm    		 Subcapsular hematoma 10-50% surface
    area; intraparenchymal hematoma <5 cm
        Parenchymal laceration 1-3 cm Parenchymal laceration 1-3 cm Parenchymal laceration 1-3 cm
             
    III  3  Subcapsular hematoma >50% surface area;
    ruptured subcapsular or intraparenchymal
    hematoma ≥5 cm    		 Subcapsular hematoma >50% surface area or
    expanding; ruptured subcapsular or
    intraparenchymal hematoma ≥5 cm    		 Subcapsular hematoma >50% surface area;
    ruptured subcapsular or intraparenchymal
    hematoma ≥5 cm
        Parenchymal laceration >3 cm depth Parenchymal laceration >3 cm depth Parenchymal laceration >3 cm depth
             
    IV 4 Any injury in the presence of a splenic
    vascular injury or active bleeding confined
    within splenic capsule    		 Parenchymal laceration involving segmental or
    hilar vessels producing >25% devascularization    		 Parenchymal laceration involving segmental or
    hilar vessels producing >25% devascularization
        Parenchymal laceration involving segmental or
    hilar vessels producing >25% devascularization    		    
             
    V 5  Any injury in the presence of a splenic vascular
    injury with active bleeding extended beyond
    the spleen into the peritoneum    		 Hilar vascular injury with devascularizes
    the spleen    		 Hilar vascular injury with devascularizes
    the spleen
        Shattered spleen Shattered spleen Shattered spleen
    Vascular injury is defined as a pseudoaneurysm or arteriovenous fistula and appears as a focal collection of vascular contrast that decreases in attenuation with delayed imaging. Active bleeding from a vascular injury presents as vascular contrast, focal or diffuse, that increases in size or attenuation in delayed phase. Vascular thrombosis can lead to organ infarction.
    Grade based on highest grade assessment made on imaging, at operation or on pathologic specimen.
    More than one grade of splenic injury may be present and should be classified by the higher grade of injury.
    Advance one grade for multiple injuries up to grade III.

    From Kozar et al.; with permission

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    Table 8

    Liver Injury Scale (2018 revision)
    AAST Grade AIS Severity Imaging Criteria (CT Findings) Operative Criteria Pathologic Criteria
    I 2 Subcapsular hematoma <10% surface area  Subcapsular hematoma <10% surface area  Subcapsular hematoma <10% surface area 
        Parenchymal laceration <1 cm depth Parenchymal laceration <1 cm depth Parenchymal laceration <1 cm depth
          Capsular tear  Capsular tear 
             
    II 2 Subcapsular hematoma 10-50% surface area; intraparenchymal hematoma <10 cm in diameter Subcapsular hematoma 10-50% surface area; intraparenchymal hematoma <10 cm in diameter Subcapsular hematoma 10-50% surface
    area; intraparenchymal hematoma
    <10 cm in diameter
        Laceration 1-3 cm in depth and
    ≤10 cm length    		 Laceration 1-3 cm in depth and
    ≤10 cm length    		 Laceration 1-3 cm in depth and
    ≤10 cm length
             
    III  3  Subcapsular hematoma >50% surface area;
    ruptured subcapsular or parenchymal
    hematoma     		 Subcapsular hematoma >50% surface area or
    expanding; ruptured subcapsular or
    parenchymal hematoma    		 Subcapsular hematoma >50% surface area;
    ruptured subcapsular or intraparenchymal
    hematoma 
        Intrparenchymal laceration >10 cm Intraparenchymal hematoma >10 cm Intraparenchymal hematoma >10 cm
        Laceration >3 cm depth Laceration >3 cm depth Laceration >3 cm depth
        Any injury in the presence of a liver
    vascular injury or active bleeding
    contained within liver parenchyma    		    
             
    IV 4 Parenchymal disruption involving
    25-75% of a hepatic lobe    		 Parenchymal disruption involving
    25-75% of a hepatic lobe    		 Parenchymal disruption involving
    25-75% of a hepatic lobe
        Active bleeding extending beyond the
    liver parenchyma into the peritoneum    		    
             
    V 5  Parenchymal disruption >75% of hepatic lobe Parenchymal disruption >75% of hepatic lobe Parenchymal disruption >75% of hepatic lobe
        Juxtahepatic venous injury to include
    retrohepatic vena cava and central
    major hepatic veins    		 Juxtahepatic venous injury to include
    retrohepatic vena cava and central
    major hepatic veins    		 Juxtahepatic venous injury to include
    retrohepatic vena cava and central
    major hepatic veins
    Vascular injury is defined as a pseudoaneurysm or arteriovenous fistula and appears as a focal collection of vascular contrast that decreases in attenuation with delayed imaging. Active bleeding from a vascular injury presents as vascular contrast, focal or diffuse, that increases in size or attenuation in delayed phase. Vascular thrombosis can lead to organ infarction.
    Grade based on highest grade assessment made on imaging, at operation or on pathologic specimen.
    More than one grade of liver injury may be present and should be classified by the higher grade of injury.
    Advance one grade for multiple injuries up to grade III.

    From Kozar et al.; with permission
     

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    Table 9

    Extrahepatic billiary tree injury scale
    Grade* Description of injury ICD-9 AIS-90
           
    I Gallbladder contusion/hematoma 868.02 2
      Portal triad contusion 868.02 2
    II Partial gallbladder avulsion from liver bed; cystic duct intact 868.02 2
      Laceration or perforation of the gallbladder 868.12 2
    III Complete gallbladder avulsion from liver bed 868.02 3
      Cystic duct laceration 868.12 3
    IV Partial or complete right hepatic duct laceration 868.12 3
      Partial or complete left hepatic duct laceration 868.12 3
      Partial common hepatic duct laceration (<50%) 868.12 3
      Partial common bile duct laceration (<50%) 868.12 3
    V >50% transection of common hepatic duct 868.12 3-4
      >50% transection of common bile duct 868.12 3-4
      Combined right and left hepatic duct injuries 868.12 3-4
      Intraduodenal or intrapancreatic bile duct injuries 868.12 3-4
    *Advance one grade for multiple injuries up to grade III.

    From Moore et al. [5]; with permission

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    Table 10

    Pancreas Injury Scale
    Grade* Type of Injury Description of Injury ICD-9 AIS-90
             
    I Hematoma Minor contusion without duct injury 863.81-863.84 2
      Laceration Superficial laceration without duct injury   2
             
    II Hematoma Major contusion without duct injury or tissue loss 863.81-863.84 2
      Laceration Major laceration without duct injury or tissue loss   3
             
    III Laceration Distal transection or parenchymal injury with duct injury 863.92/863.94 3
             
    IV Laceration Proximal? transection or parenchymal injury involving ampulla 863.91 4
    V Laceration Massive disruption of pancreatic head 863.91 5
    *Advance one grade for multiple injuries up to grade III. *863.51,863.91 - head; 863.99,862.92-body;863.83,863.93-tail. aProximal pancreas is to the patients’ right of the superior mesenteric vein.

    From Moore et al. [6]: with permission.

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    Table 11

    Esophagus injury scale
    Grade* Description of injury ICD-9 AIS-90
           
    I Contusion/hematoma 862.22/.32 2
      Partial thickness laceration 862.22/.32 3
    II Laceration <50% circumference 862.22/.32 4
    III Laceration >50% circumference 862.22/.32 4
    IV Segmental loss or devascularization <2cm 862.22/.32 5
    V Segmental loss or devascularization >2cm 862.22/.32 5
    *Advance one grade for multiple lesions up to grade III.

    From Moore et al [5]; with permission

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    Table 12

    Stomach injury scale
    Grade* Description of injury ICD-9 AIS-90
           
    I Contusion/hematoma 863.0/.1 2
      Partial thickness laceration 863.0/.1 2
    II Laceration <2cm in GE junction or pylorus 863.0/.1 3
      <5cm in proximal 1/3 stomach 863.0/.1 3
      <10cm in distal 2/3 stomach 863.0/.1 3
    III Laceration >2cm in GE junction or pylorus 863.0/.1 3
      >5cm in proximal 1/3 stomach 863.0/.1 3
      >10cm in distal 2/3 stomach 863.0/.1 3
    IV Tissue loss or devascularization <2/3 stomach 863.0/.1 4
    V Tissue loss or devascularization >2/3 stomach 863.0/.1 4
    *Advance one grade for multiple lesions up to grade III. GE-gastroesophageal.

    From Moore et al.[5]; with permission

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    Table 13

    Duodenum injury scale
    Grade* Type of injury Description of injury ICD-9 AIS-90
             
    I Hematoma Involving single portion of duodenum 863.21 2
      Laceration Partial thickness, no perforation 863.21 3
    II Hematoma Involving more than one portion 863.21 2
      Laceration Disruption <50% of circumference 863.31 4
    III Laceration Disruption 50%-75% of circumference of D2 863.31 4
        Disruption 50%-100% of circumference of D1,D3,D4 863.31 4
             
    IV Laceration Disruption >75% of circumference of D2 863.31 5
        Involving ampulla or distal common bile duct   5
    V Laceration Massive disruption of duodenopancreatic complex 863.31 5
      Vascular Devascularization of duodenum 863.31 5
    *Advance one grade for multiple injuries up to grade III. D1-first position of duodenum; D2-second portion of duodenum; D3-third portion of duodenum; D4-fourth portion of duodenum

    From Moore et al. [6]; with permission.

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    Table 14

    Small bowel injury scale
    Grade* Type of injury Description of injury ICD-9 AIS-90
             
    I Hematoma Contusion or hematoma without devascularization 863.20 2
             
      Laceration Partial thickness, no perforation 863.20 2
    II Laceration Laceration <50% of circumference 863.30 3
    III Laceration Laceration > 50% of circumference without transection 863.30 3
             
    IV Laceration Transection of the small bowel 863.30 4
    V Laceration Transection of the small bowel with segmental tissue loss 863.30 4
             
      Vascular Devascularized segment 863.30 4
    *Advance one grade for multiple injuries up to grade III.

    From Moore et al. [6]; with permission

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    Table 15

    Colon injury scale
    Grade* Type of injury Description of injury ICD-9 AIS-90
             
    I Hematoma Contusion or hematoma without devascularization 863.40-863.44 2
             
      Laceration Partial thickness, no perforation 863.40-863.44 2
    II Laceration Laceration <50% of circumference 863.50-863.54 3
    III Laceration Laceration > 50% of circumference without transection 863.50-863.54 3
             
    IV Laceration Transection of the colon 863.50-863.54 4
    V Laceration Transection of the colon with segmental tissue loss 863.50-863.54 4
      Vascular Devascularized segment 863.50-863.54 4
    *Advance one grade for multiple injuries up to grade III. *863.41,863.51-ascending;863.42, 863.52-transverse;863.45,863.53-descending; 863.44,863.54-rectum.

    From Moore et al. [6]; with permission

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    Table 16

    Rectum injury scale
    Grade* Type of injury Description of injury ICD-9 AIS-90
             
    I Hematoma Contusion or hematoma without devascularization 863.45 2
             
      Laceration Partial-thickness laceration 863.45 2
    II Laceration Laceration < 50% of circumference 863.55 3
    III Laceration Laceration > 50% of circumference 863.55 4
    IV Laceration Full-thickness laceration with extension into the perineum 863.55 5
             
    V Vascular Devascularized segment 863.55 5
    *Advance one grade for multiple injuries up to grade III.

    From Moore et al. [6]; with permission

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    Table 17

    Abdominal vascular injury scale
    Grade* Description of injury ICD-9 AIS-90
           
    I Non-named superior mesenteric artery or superior mesenteric vein branches 902.20/.39 NS
      Non-named inferior mesenteric artery or inferior mesenteric vein branches 902.27/.32 NS
      Phrenic artery or vein 902.89 NS
      Lumbar artery or vein 902.89 NS
      Gonadal artery or vein 902.89 NS
      Ovarian artery or vein 902.81/.82 NS
      Other non-named small arterial or venous structures requiring ligation 902.90 NS
    II Right, left, or common hepatic artery 902.22 3
      Splenic artery or vein 902.23/.34 3
      Right or left gastric arteries 902.21 3
      Gastroduodenal artery 902.24 3
      Inferior mesenteric artery, or inferior mesenteric vein, trunk 902.27/.32 3
      Primary named branches of messenteric artery (e.g., ileocolic artery) or messenteric vein 902.26/.31 3
      Other names abdominal vessels requiring ligation or repair 902.89 3
    III Superior mesenteric vein, trunk 902.31 3
      Renal artery or vein 902.41/.42 3
      Illiac artery or vein 902.53/.54 3
      Hypogastric artery or vein 902.51/.52 3
      Vena cava, infrarenal 902.10 3
    IV Superior mesenteric artery, trunk 902.25 3
      Celiac axis proper 902.24 3
      Vena cava, suprarenal and infrahepatic 902.10 3
      Aorta, infrarenal 902.00 4
    V Portal vein Extraparenchymal hepatic vein 902.33 902.11 3 3(hepatic vein)
          5 (liver + veins)
      Vena cava, retrohepatic or suprahepatic 902.19 5
      Aorta suprarenal, subdiaphragmatic 902.00 4
    *This classification system is applicable to extraparenchymal vascular injuries. If the vessel injury is within 2 cm of the organ parenchyma, refer to specific organ injury scale. Increase one grade for multiple grade III or IV injuries involving > 50% vessel circumference. Downgrade one grade if <25% vessel circumference laceration for grades IV or V. NS-not scored.

    From Moore et al [2]; with permission

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    Table 18

    Adrenal organ injury scale
    Grade* Description of injury ICD-9 AIS-90
           
    I Contusion 868.01/.11 1
    II Laceration involving only cortex (<2 cm) 868.01/.11 1
    III Laceration extending into medulla (> 2 cm) 868.01/.11 2
    IV >50% parenchymal destruction 868.01/.11 2
    V Total parenchymal destruction (including massive intraparenchymal hemorrhage) 868.01/.11 3
      Avulsion from blood supply    
    *Advance one grade for bilateral lesions up to grade V

    From Moore et al [1]; with permission

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    Table 8

    Kidney Injury Scale (2018 revision)
    AAST Grade AIS Severity Imaging Criteria (CT Findings) Operative Criteria Pathologic Criteria
    I 2 Subcapsular hematoma and/or parenchymal
    contusion without laceration    		 Nonexpanding subcapsular hematoma Subcapsular hematoma or parenchymal
    contusion without parenchymal laceration
          Parenchymal contusion without laceration  
             
    II 2 Perirenal hematoma confined to Gerota fascia Nonexpanding perirenal hematoma
    confined to Gerota fascia    		 Perirenal hematoma confined to
    Gerota fascia
        Renal parenchymal laceration ≤1 cm depth 
    without urinary extravasation    		 Renal parenchymal laceration ≤1 cm depth
    without urinary extravasation    		 Renal parenchymal laceration ≤1 cm 
    depth without urinary extravasation
             
    III  3  Renal parenchymal laceration >1 cm depth without
    collecting system rupture or urinary extravasation    		 Renal parenchymal laceration >1 cm depth
    without collecting system rupture or
    urinary extravasation    		 Renal parenchymal laceration >1 cm
    depth without collecting system
    rupture or urinary extravasation
        Any injury in the presence of a kidney vascular injury
    or active bleeding contained within Gerota fascia    		    
             
    IV 4 Parenchymal laceration extending into urinary
    collecting system with urinary extravasation    		 Parenchymal laceration extending into urinary
    collecting system with urinary extravasation    		 Parenchymal laceration extending into urinary
    collecting system
        Renal pelvis laceration and/or complete
    ureteropelvic disruption    		 Renal pelvis laceration and/or complete
    ureteropelvic disruption    		 Renal pelvis laceration and/or complete
    ureteropelvic disruption
        Segmental renal vein or artery injury Segmental renal vein or artery injury Segmental renal vein or artery injury 
        Active bleeding beyond Gerota fascia into the
    retroperitoneum or peritoneum    		 Segmental or complete kidney infarction(s)
    due to vessel thrombosis without active bleeding    		 Segmental or complete kidney infarction(s)
    due to vessel thrombosis without active bleeding
        Segmental or complete kidney infarction(s)
    due to vessel thrombosis without active bleeding    		    
    V 5  Main renal artery or vein laceration or
    avulsion of hilum    		 Main renal artery or vein laceration or
    avulsion of hilum    		 Main renal artery or vein laceration or
    avulsion of hilum
        Devascularized kidney with active bleeding Devascularized kidney with active bleeding Devascularized kidney
        Shattered kidney with loss of identifiable 
    parenchymal renal anatomy    		 Shattered kidney with loss of identifiable 
    parenchymal renal anatomy    		 Shattered kidney with loss of identifiable 
    parenchymal renal anatomy
    Vascular injury is defined as a pseudoaneurysm or arteriovenous fistula and appears as a focal collection of vascular contrast that decreases in attenuation with delayed imaging. Active bleeding from a vascular injury presents as vascular contrast, focal or diffuse, that increases in size or attenuation in delayed phase. Vascular thrombosis can lead to organ infarction.
    Grade based on highest grade assessment made on imaging, at operation or on pathologic specimen.
    More than one grade of kidney injury may be present and should be classified by the higher grade of injury.
    Advance one grade for multiple injuries up to grade III.

    From Kozar et al.; with permission
     

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    Table 20

    Ureter injury scale
    Grade* Type of injury Description of injury ICD-9 AIS-90
             
    I Hematoma Contusion or hematoma without devascularization 867.2/867.3 2
             
    II Laceration < 50% transection 867.2/867.3 2
             
    III Laceration > 50% transection 867.2/867.3 3
             
    IV Laceration Complete transection with < 2cm devascularization 867.2/867.3 3
             
    V Laceration Avulsion with > 2cm of devascularization 867.2/867.3 3
    *Advance one grade for bilateral up to grade III.

    From Moore et al. [2]; with permission

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    Table 21

    Bladder injury scale
    Grade* Injury type Description of injury ICD-9 AIS-90
             
    I Hematoma Contusion, intramural hematoma 867.0/867.1 2
      Laceration Partial thickness   3
             
    II Laceration Extraperitoneal bladder wall laceration <2 cm 867.0/867.1 4
             
    III Laceration Extraperitoneal (>2cm) or intraperitoneal (<2cm) bladder wall laceration 867.0/867.1 4
             
    IV Laceration Intraperitoneal bladder wall laceration >2cm 867.0/867.1 4
             
    V Laceration Intraperitoneal or extraperitoneal bladder wall laceration extending into the bladder neck or ureteral orifice (trigone) 867.0/867.1 4
    *Advance one grade for multiple lesions up to grade III

    From Moore et al. [2]; with permission

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    Table 22

    Urethra injury scale
    Grade* Injury type Description of injury ICD-9 AIS-90
             
    I Contusion Blood at urethral meatus; retrography normal 867.0/867.1 2
             
    II Stretch injury Elongation of urethra without extravasation on urethrography 867.0/867.1 2
             
    III Partial disruption Extravasation of urethrography contrast at injury site with visualization in the bladder 867.0/867.1 2
             
    IV Complete disruption Extravasation of urethrography contrast at injury site without visualization in the bladder; <2cm of urethra seperation 867.0/867.1 3
             
    V Complete disruption Complete transaction with >2 cm urethral separation, or extension into the prostate or vagina 867.0/867.1 4
             

    From Moore et al. [2]; with permission

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    Table 23

    Uterus (nonpregnant) injury scale
    Grade* Description of injury ICD-9 AIS-90
           
    I Contusion/hematoma 867.4/.5 2
    II Superficial laceration (<1 cm) 867.4/.5 2
    III Deep laceration (> 1 cm) 867.4/.5 3
    IV Laceration involving uterine artery 902.55 3
    V Avulsion/devascularization 867.4/.5 3
    *Advance one grade for multiple injuries up to grade III

    From Moore et al. [5]; with permission

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    Table 24

    Uterus (pregnant) injury scale
    Grade* Description of injury ICD-9 AIS-90
           
    I Contusion or hematoma (without placental abruption) 867.4/.5 2
    II Superficial laceration (<1cm) or partial placental abruption <25% 867.4/.5 3
      Deep laceration (>1cm) occurring in second trimester or placental abruption >25%    
    III but <50% 867.4/.5 3
      Deep laceration (>1cm) in third trimester    
      Laceration involving uterine artery 867.4/.5 4
    IV Deep laceration (>1cm) with >50% placental abruption 902.55 4
      Uterine rupture 867.4/.5 4
    V Second trimester    
      Third trimester 867.4/.5 4
      Complete placental abruption 867.4/.5 5
        867.4/.5 4-5
    *Advance one grade for multiple injuries up to grade III

    From Moore et al. [5]; with permission

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    Table 25

    Fallopian tube injury scale
    Grade* Description of injury ICD-9 AIS-90
           
    I Hematoma or contusion 867.6/.7 2
    II Laceration <50% circumference 867.6/.7 2
    III Laceration >50% circumference 867.6/.7 2
    IV Transection 867.6/.7 2
    V Vascular injury; devascularized segment 902.89 2
    *Advance one grade for bilateral injuries up to grade III

    From Moore et al. [5]; with permission

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    Table 26

    Ovary injury scale
    Grade* Description of injury ICD-9 AIS-90
           
    I Contusion or hematoma 867.6/.7 1
    II Superficial laceration (depth <0.5 cm) 867.6/.7 2
    III Deep laceration (depth > 0.5 cm) 867.8/.7 3
    IV Partial disruption or blood supply 902.81 3
    V Avulsion or complete parenchymal destruction 902.81 3
    *Advance one grade for bilateral injuries up to grade III

    From Moore et al. [5]; with permission

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    Table 27

    Vagina injury scale
    Grade* Description of injury ICD-9 AIS-90
           
    I Contusion or hematoma 922.4 1
    II Laceration, superficial (mucosa only) 878.6 1
    III Laceration, deep into fat or muscle 878.6 2
    IV Laceration, complex, into cervix or peritoneum 868.7 3
    V Injury into adjacent organs (anus, rectum, urethra, bladder) 878.7 3
    *Advance one grade for multiple injuries up to grade III

    From Moore et al. [5]; with permission

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    Table 28

    Vulva injury scale
    Grade* Description of injury ICD-9 AIS-90
           
    I Contusion or hematoma 922.4 1
    II Laceration, superficial (skin only) 878.4 1
    III Laceration, deep (into fat or muscle) 878.4 2
    IV Avulsion; skin, fat or muscle 878.5 3
    V Injury into adjacent organs (anus, rectum, urethra, bladder) 878.5 3
    *Advance one grade for multiple injuries up to grade III

    From Moore et al. [5]; with permission

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    Table 29

    Testis injury scale
    Grade* Description of injury ICD-9 AIS-90
           
    I Contusion/hematoma 911.0/922.4 1
    II Subclinical laceration of tunica albuginea 922.4 1
    III Laceration of tunica albuginea with <50% parenchymal loss 878.2 2
    IV Major laceration of tunica albuginea with >50% parenchymal loss 878.3 2
    V Total testicular destruction or avulsion 878.3 2
           
    *Advance one grade for bilateral lesions up to grade V

    From Moore et al [1]; with permission

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    Table 30

    Scrotum injury scale
    Grade Description of injury ICD-9 AIS-90
           
    I Contusion 922.4 1
    II Laceration <25% of scortal diameter 878.2 1
    III Laceration >25% of scrotal diameter 878.3 2
    IV Avulsion <50% 878.3 2
    V Avulsion >50% 878.3 2
    From Moore et al [1]; with permission

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    Table 31

    Penis injury scale
    Grade* Description of injury ICD-9 AIS-90
           
    I Cutaneous laceration/contusion 911.0-922.4 1
    II Buck’s fascia (cavernosum) laceration without tissue loss 878.0 1
    III Cutaneous avulsion 878.1 3
      Laceration through glans/meatus    
      Cavemosal or urethral defect <2cm    
    IV Partial penectomy 878.1 3
      Cavarnosal or urethral defect > 2 cm    
    V Total penectomy 876.1 3
    *Advance one grade for multiple injuries up to grade III

    From Moore et al. [1]; with permission

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    Table 32

    Peripheral vascular organ injury scale
    Grade* Description of injury ICD-9 AIS-90
           
    I Digital artery/vein 903.5 1-3
      Palmar artery/vein 903.4 1-3
      Deep palmar artery/vein 904.6 1-3
      Dorsalla pedia artery 904.7 1-3
      Plantar artery/vein 904.5 1-3
      Non-named arterial/venous branches 903.8/904.7 1-3
    II Basilic/cephalic vein 903.8 1-3
      Saphenous vein 904.3 1-3
      Radial artery 903.2 1-3
      Ulnar artery 903.3 1-3
    III Axillary vein 903.02 2-3
      Superficial/deep femoral vein 903.02 2-3
      Popliteal vein 904.42 2-3
      Brachial artery 903.1 2-3
      Anterior tibial artery 904.51/904.52 1-3
      Posterior tibial artery 904.53/904.54 1-3
      Peroneal artery 904.7 1-3
      Tibioperoneal trunk 904.7 2-3
    IV Superficial/deep femoral artery 904.1/904.7 3-4
      Popliteal artery 904.41 2-3
    V Axillary artery 903.01 2-3
      Common femoral artery 904.0 3-4
    *Increase one grade for multiple grade III or IV injuries involving >50% vessel circumference. Decrease one grade for < 25% vessel circumference disruption for grades IV or V

    From Moore et al [1]; with permission

    All ISS tables require permission from Wolters Kluwer.

     

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