OR G A N I N J URY S C AL E
V E R INJU RY
L I VE
SP LEE N I NJURY
PAGE 1
AAST ORGAN INJURY SCALE LIVER/SPLEEN:
THE NTDB EXPERIENCE 2008–2012
AUTHO RS
• The American College of Surgeons
Committee on Trauma
• American Association for the
Surgery of Trauma
• Glen H. Tinkoff, MD, FACS
• Thomas J. Esposito, MD, FACS
• Stanford M. Goldman, MD
• O. Clark West, MD
• Michael McGonigal, MD, FACS
• Paul R. G. Cunningham, MB, BS, FACS
• John Fields, MD, FACS
• Henri Ford, MD, FACS
• Dennis W. Ashley, MD, FACS
This publication is designed to offer information suitable for use by an appropriately trained physician.
The information provided is not intended to be comprehensive or to offer a defined standard of care.
The user agrees to release and idemnify the American College of Surgeons from claims arising from use of the publication.
© 2014 American College of Surgeons
OR G A N I N J URY S C AL E
L I VE R INJU RY
S PLE E N INJU RY
PAG E 2
AUTHO RS
• The American College of Surgeons
Committee on Trauma
• American Association for the
Surgery of Trauma
• Glen H. Tinkoff, MD, FACS
• Thomas J. Esposito, MD, FACS
• Stanford M. Goldman, MD
• O. Clark West, MD
• Michael McGonigal, MD, FACS
• Paul R. G. Cunningham, MB, BS, FACS
• John Fields, MD, FACS
• Henri Ford, MD, FACS
• Dennis W. Ashley, MD, FACS
This publication is designed to offer information suitable for use by an appropriately trained physician.
The information provided is not intended to be comprehensive or to offer a defined standard of care.
The user agrees to release and idemnify the American College of Surgeons from claims arising from use of the publication.
© 2014 American College of Surgeons
Liver Anatomy Overview
L I V E R INJU RY
S PLE E N INJU RY
PAGE 3
▲
OR G A N I N J URY S C AL E
Liver Injury Scaling
Right Hemiliver (Right Liver)
Liver Injury Images
Left Hemiliver (Left Liver)
Inferior Vena Cava
Middle Heptic Vein
All Liver Injury Statistics
Right Heptic Vein
Left Heptic Vein
Isolated Liver Injury Statistics
Isolated Liver Injury without
Severe Head Trauma Statistics
2
© 2006 WebMD Inc All rights reserved
8
Isolated Liver Injury without
Severe Head Trauma or Early
Death ≤24 Hours Statistics
1, 9
7
3
4
Falciform
Ligament
5
Portal Vein
6
Common
Heptic Artery
Common
Bile Duct
Right Posterior
Section
National Trauma Data Bank (NTDB)
Right Anterior
Section
Left Medial
Section
Left Lateral
Section
© 2014 American College of Surgeons
OR G A N I N J URY S C AL E
L I V E R INJU RY
S PLE E N INJU RY
PAGE 4
Liver Injury Scaling
▲
Liver Anatomy Overview
GRADE*
I N J U RY D E S C R I P TI O N
ICD -9
AIS 90
➊
Subcapsular hematoma, <10% surface area; Capsular tear, <1 cm
parenchymal depth
864.01
864.11
864.02
864.12
2
➋
Subcapsular hematoma, 10%-15% surface area; intraparenchymal, <10 cm in diameter;
laceration 1-3 cm parenchymal depth, <10 cm in length
864.01
864.11
864.03
864.13
2
➌
Subcapsular hematoma, >50% surface area or expanding; ruptured subcapsular or
parenchymal hematoma; intraparenchymal hematoma >10 cm or expanding;
laceration >3 cm parenchymal depth
864.04
864.14
3
➍
Parenchymal disruption involving 25% to 75% of hepatic lobe or 1-3 Couinaud’s
segments within a single lobe
864.04
864.14
4
➎
Parenchymal disruption involving >75% of hepatic lobe or >3 Couinaud’s segments
within a single lobe; vascular juxtahepatic venous injuries; i.e., retrohepatic vena
cava/central major hepatic veins
5
➏
Vascular hepatic avulsion
6
Liver Injury Images
All Liver Injury Statistics
Isolated Liver Injury Statistics
Isolated Liver Injury without
Severe Head Trauma Statistics
Isolated Liver Injury without
Severe Head Trauma or Early
Death ≤24 Hours Statistics
➌
*Advance one grade for multiple injuries, up to grade
From Moore EE, Cogbill
TH, Jurkovich GJ, et al. Organ injury scaling V: Spleen and liver (1994 revision).
J Trauma. 1995;38:323. With permission.
National Trauma Data Bank (NTDB)
NTDB VERSION 8-11
© 2014 American College of Surgeons
OR G A N I N J URY S C AL E
L I V E R INJU RY
S PLE E N INJU RY
PAGE 5
Liver Anatomy Overview
Liver Injury Images
▲
Liver Injury Scaling
All Liver Injury Statistics
Isolated Liver Injury Statistics
Isolated Liver Injury without
Severe Head Trauma Statistics
▲
Isolated Liver Injury without
Severe Head Trauma or Early
Death ≤24 Hours Statistics
GRADE
➊
I N J U RY D E S C R I P TI O N
Subcapsular hematoma, <10% surface area; capsular tear,
<1 cm parenchymal depth
National Trauma Data Bank (NTDB)
ICD -9
AIS 90
864.01
864.11
864.02
864.12
2
© 2014 American College of Surgeons
OR G A N I N J URY S C AL E
L I V E R INJU RY
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PAG E 6
Liver Anatomy Overview
Liver Injury Scaling
Liver Injury Images
All Liver Injury Statistics
Isolated Liver Injury Statistics
Isolated Liver Injury without
Severe Head Trauma Statistics
Isolated Liver Injury without
Severe Head Trauma or Early
Death ≤24 Hours Statistics
GRADE
➊
I N J U RY D E S C R I P TI O N
Subcapsular hematoma, <10% surface area; capsular tear,
<1 cm parenchymal depth
National Trauma Data Bank (NTDB)
ICD -9
AIS 90
864.01
864.11
864.02
864.12
2
© 2014 American College of Surgeons
OR G A N I N J URY S C AL E
L I V E R INJU RY
S PLE E N INJU RY
PAG E 7
Liver Anatomy Overview
Liver Injury Scaling
Liver Injury Images
All Liver Injury Statistics
Isolated Liver Injury Statistics
Isolated Liver Injury without
Severe Head Trauma Statistics
Isolated Liver Injury without
Severe Head Trauma or Early
Death ≤24 Hours Statistics
GRADE
➋
I N J U RY D E S C R I P TI O N
Subcapsular hematoma, 10%-15% surface area; intraparenchymal, <10 cm in diameter;
laceration 1-3 cm parenchymal depth, <10 cm in length
National Trauma Data Bank (NTDB)
ICD -9
AIS 90
864.01
864.11
864.03
864.13
2
© 2014 American College of Surgeons
OR G A N I N J URY S C AL E
L I V E R INJU RY
S PLE E N INJU RY
PAGE 8
Liver Anatomy Overview
Liver Injury Scaling
Liver Injury Images
All Liver Injury Statistics
Isolated Liver Injury Statistics
Isolated Liver Injury without
Severe Head Trauma Statistics
Isolated Liver Injury without
Severe Head Trauma or Early
Death ≤24 Hours Statistics
GRADE
➋
I N J U RY D E S C R I P TI O N
Subcapsular hematoma, 10%-15% surface area; intraparenchymal,
<10 cm in diameter; laceration 1-3 cm parenchymal depth, <10 cm in length
National Trauma Data Bank (NTDB)
ICD -9
AIS 90
864.01
864.11
864.03
864.13
2
© 2014 American College of Surgeons
OR G A N I N J URY S C AL E
L I V E R INJU RY
S PLE E N INJU RY
PAG E 9
Liver Anatomy Overview
Liver Injury Scaling
Liver Injury Images
All Liver Injury Statistics
Isolated Liver Injury Statistics
Isolated Liver Injury without
Severe Head Trauma Statistics
Isolated Liver Injury without
Severe Head Trauma or Early
Death ≤24 Hours Statistics
GRADE
➌
I N J U RY D E S C R I P TI O N
Subcapsular hematoma, >50% surface area or expanding; ruptured subcapsular
or parenchymal hematoma; intraparenchymal hematoma >10 cm or expanding;
laceration >3 cm parenchymal depth
National Trauma Data Bank (NTDB)
ICD -9
AIS 90
864.04
864.14
3
© 2014 American College of Surgeons
OR G A N I N J URY S C AL E
L I V E R INJU RY
S PLE E N INJU RY
PAG E 1 0
Liver Anatomy Overview
Liver Injury Scaling
Liver Injury Images
All Liver Injury Statistics
Isolated Liver Injury Statistics
Isolated Liver Injury without
Severe Head Trauma Statistics
Isolated Liver Injury without
Severe Head Trauma or Early
Death ≤24 Hours Statistics
GRADE
➌
I N J U RY D E S C R I P TI O N
Subcapsular hematoma, >50% surface area or expanding; ruptured subcapsular or
parenchymal hematoma; intraparenchymal hematoma >10 cm or expanding;
laceration >3 cm parenchymal depth
National Trauma Data Bank (NTDB)
ICD -9
AIS 90
864.04
864.14
3
© 2014 American College of Surgeons
OR G A N I N J URY S C AL E
L I V E R INJU RY
S PLE E N INJU RY
PAG E 1 1
Liver Anatomy Overview
Liver Injury Scaling
Liver Injury Images
All Liver Injury Statistics
Isolated Liver Injury Statistics
Isolated Liver Injury without
Severe Head Trauma Statistics
Isolated Liver Injury without
Severe Head Trauma or Early
Death ≤24 Hours Statistics
GRADE
➍
I N J U RY D E S C R I P TI O N
Parenchymal disruption involving 25%-75% of hepatic lobe or 1-3
Couinaud’s segments within a single lobe
National Trauma Data Bank (NTDB)
ICD -9
AIS 90
864.04
864.14
4
© 2014 American College of Surgeons
OR G A N I N J URY S C AL E
L I V E R INJU RY
S PLE E N INJU RY
PAGE 1 2
Liver Anatomy Overview
Liver Injury Scaling
Liver Injury Images
All Liver Injury Statistics
Isolated Liver Injury Statistics
Isolated Liver Injury without
Severe Head Trauma Statistics
Isolated Liver Injury without
Severe Head Trauma or Early
Death ≤24 Hours Statistics
GRADE
➍
I N J U RY D E S C R I P TI O N
Parenchymal disruption involving 25%-75% of hepatic lobe or 1-3
Couinaud’s segments within a single lobe
National Trauma Data Bank (NTDB)
ICD -9
AIS 90
864.04
864.14
4
© 2014 American College of Surgeons
OR G A N I N J URY S C AL E
L I V E R INJU RY
S PLE E N INJU RY
PAG E 1 3
Liver Anatomy Overview
Liver Injury Scaling
Liver Injury Images
All Liver Injury Statistics
Isolated Liver Injury Statistics
Isolated Liver Injury without
Severe Head Trauma Statistics
Isolated Liver Injury without
Severe Head Trauma or Early
Death ≤24 Hours Statistics
GRADE
➎
I N J U RY D E S C R I P TI O N
ICD -9
Parenchymal disruption involving >75% of hepatic lobe or >3 Couinaud’s segments
within a single lobe; vascular juxtahepatic venous injuries; i.e., retrohepatic vena
cava/central major hepatic veins
National Trauma Data Bank (NTDB)
AIS 90
5
© 2014 American College of Surgeons
OR G A N I N J URY S C AL E
L I V E R INJU RY
S PLE E N INJU RY
PAGE 1 4
Liver Anatomy Overview
LI V E R I N J U R I E S - M O R TA LIT Y
Liver Injury Scaling
Liver Injury Images
M O R TA L I T Y
All Liver Injury Statistics
Isolated Liver Injury Statistics
Isolated Liver Injury without
Severe Head Trauma Statistics
Isolated Liver Injury without
Severe Head Trauma or Early
Death ≤24 Hours Statistics
100%
80%
60%
40%
Liver Injuries-Mortality
Liver Injuries-OR
20%
Liver Injuries-LOS
Liver Injuries-ICU
0%
1 & 2
3
4
5
6
TOTA L
OIS GRADE
NTDB VERSION 8-11
National Trauma Data Bank (NTDB)
© 2014 American College of Surgeons
OR G A N I N J URY S C AL E
L I V E R INJU RY
S PLE E N INJU RY
PAGE 1 5
Liver Anatomy Overview
LI V E R I N J U R I E S - O P E R ATI N G R O O M
Liver Injury Scaling
Liver Injury Images
Isolated Liver Injury Statistics
OR
All Liver Injury Statistics
Isolated Liver Injury without
Severe Head Trauma Statistics
40%
30%
Isolated Liver Injury without
Severe Head Trauma or Early
Death ≤24 Hours Statistics
20%
Liver Injuries-Mortality
Liver Injuries-OR
Liver Injuries-LOS
10%
Liver Injuries-ICU
0%
1 & 2
3
4
5
6
TOTA L
OIS GRADE
NTDB VERSION 8-11
National Trauma Data Bank (NTDB)
© 2014 American College of Surgeons
OR G A N I N J URY S C AL E
L I V E R INJU RY
S PLE E N INJU RY
PAGE 1 6
Liver Anatomy Overview
LI V E R I N J U R I E S - LO S
Liver Injury Scaling
Liver Injury Images
All Liver Injury Statistics
Isolated Liver Injury without
Severe Head Trauma Statistics
Isolated Liver Injury without
Severe Head Trauma or Early
Death ≤24 Hours Statistics
14
L O S ( DAYS )
Isolated Liver Injury Statistics
12
10
8
6
Liver Injuries-Mortality
Liver Injuries-OR
4
Liver Injuries-LOS
Liver Injuries-ICU
2
0
1 & 2
3
4
5
6
TOTA L
OIS GRADE
NTDB VERSION 8-11
National Trauma Data Bank (NTDB)
© 2014 American College of Surgeons
OR G A N I N J URY S C AL E
L I V E R INJU RY
S PLE E N INJU RY
PAGE 1 7
LI V E R I N J U R I E S - I C U
I C U ( DAYS )
Liver Anatomy Overview
Liver Injury Scaling
Liver Injury Images
All Liver Injury Statistics
Isolated Liver Injury Statistics
12
10
8
Isolated Liver Injury without
Severe Head Trauma Statistics
6
Isolated Liver Injury without
Severe Head Trauma or Early
Death ≤24 Hours Statistics
4
Liver Injuries-Mortality
2
Liver Injuries-OR
Liver Injuries-LOS
0
Liver Injuries-ICU
1 & 2
3
4
5
6
TOTA L
OIS GRADE
MORTALITY (%)
OR (%)
LOS (DAYS)
MEAN ± SD (MEDIAN)
ICU (DAYS)
MEAN ± SD (MEDIAN)
OIS GRADE
N
1&2
21649
9.3%
8.7%
10.1 ± 13.9 (6.0)
7.2 ± 10.0 (3.0)
3
8090
8.4%
14.8%
10.9 ± 14.4 (6.0)
6.8 ± 10.2 (3.0)
4
5106
23.6%
27.0%
12.6 ± 18.0 (7.0)
8.4 ± 12.5 (4.0)
5
313
47.9%
34.4%
13.5 ± 22.7 (5.0)
10.7 ± 15.0 (5.0)
6
30
83.3%
35.5%
3.5 ± 7.2 (1.0)
4.5 ± 6.2 (1.0)
TOTAL
35188
11.6%
12.9%
10.7 ± 14.8 (6.0)
7.3 ± 10.6 (3.0)
5. Mortality: OIS Grades 1 & 2 = OIS Grade 3 < OIS Grade 4 < OIS Grade 5 < OIS Grade 6.
6. OR: OIS Grade 1 & 2 = OIS Grade 3 < OIS Grade 4 = OIS Grade 5 = OIS Grade 6.
7. LOS: OIS Grade 6 < OIS Grade 1 & 2 = OIS Grade 3 = OIS Grade 4 = OIS Grade 5.
8. ICU LOS: OIS Grade 6 < OIS Grade 1 & 2 = OIS Grade 3 = OIS Grade 4 = OIS Grade 5.
National Trauma Data Bank (NTDB)
NTDB VERSION 8-11
© 2014 American College of Surgeons
OR G A N I N J URY S C AL E
L I V E R INJU RY
S PLE E N INJU RY
PAGE 1 8
Liver Anatomy Overview
I S O L AT E D LI V E R I N J U R I E S - M O R TA LIT Y
Liver Injury Scaling
Liver Injury Images
Isolated Liver Injury Statistics
Isolated Liver Injury without
Severe Head Trauma Statistics
Isolated Liver Injury without
Severe Head Trauma or Early
Death ≤24 Hours Statistics
Liver Injuries-Mortality
Liver Injuries-OR
Liver Injuries-LOS
Liver Injuries-ICU
M O R TA L I T Y
All Liver Injury Statistics
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
1 & 2
3
4
5
6
TOTA L
OIS GRADE
NTDB VERSION 8-11
National Trauma Data Bank (NTDB)
© 2014 American College of Surgeons
OR G A N I N J URY S C AL E
L I V E R INJU RY
S PLE E N INJU RY
PAGE 1 9
Liver Anatomy Overview
I S O L AT E D LI V E R I N J U R I E S - O P E R ATI N G R O O M
Liver Injury Scaling
Liver Injury Images
Isolated Liver Injury Statistics
OR
All Liver Injury Statistics
30%
Isolated Liver Injury without
Severe Head Trauma Statistics
25%
Isolated Liver Injury without
Severe Head Trauma or Early
Death ≤24 Hours Statistics
20%
Liver Injuries-Mortality
15%
Liver Injuries-OR
Liver Injuries-LOS
10%
Liver Injuries-ICU
5%
0%
1 & 2
3
4
5
6
TOTA L
OIS GRADE
NTDB VERSION 8-11
National Trauma Data Bank (NTDB)
© 2014 American College of Surgeons
OR G A N I N J URY S C AL E
L I V E R INJU RY
S PLE E N INJU RY
PAG E 2 0
Liver Anatomy Overview
I S O L AT E D LI V E R I N J U R I E S - LO S
Liver Injury Scaling
Liver Injury Images
Isolated Liver Injury Statistics
Isolated Liver Injury without
Severe Head Trauma Statistics
L O S ( DAYS )
All Liver Injury Statistics
Isolated Liver Injury without
Severe Head Trauma or Early
Death ≤24 Hours Statistics
12
10
8
6
Liver Injuries-Mortality
Liver Injuries-OR
4
Liver Injuries-LOS
Liver Injuries-ICU
2
0
1 & 2
3
4
5
6
TOTA L
OIS GRADE
NTDB VERSION 8-11
National Trauma Data Bank (NTDB)
© 2014 American College of Surgeons
OR G A N I N J URY S C AL E
L I V E R INJU RY
S PLE E N INJU RY
PAGE 2 1
I S O L AT E D LI V E R I N J U R I E S - I C U
I C U ( DAYS )
Liver Anatomy Overview
Liver Injury Scaling
Liver Injury Images
All Liver Injury Statistics
9
8
7
Isolated Liver Injury Statistics
6
Isolated Liver Injury without
Severe Head Trauma Statistics
5
4
Isolated Liver Injury without
Severe Head Trauma or Early
Death ≤24 Hours Statistics
3
2
Liver Injuries-Mortality
Liver Injuries-OR
1
Liver Injuries-LOS
0
Liver Injuries-ICU
1 & 2
3
4
5
6
TOTA L
OIS GRADE
OR (%)
LOS (DAYS)
MEAN ± SD (MEDIAN)
ICU (DAYS)
MEAN ± SD (MEDIAN)
7.5%
6.8%
8.7 ± 12.2 (5.0)
6.4 ± 9.5 (3.0)
6.4%
11.7%
8.9 ± 11.4 (5.0)
5.5 ± 8.1 (2.0)
20.6%
24.0%
10.9 ± 15.0 (6.0)
7.3 ± 10.9 (3.0)
48.7%
24.1%
9.5 ± 16.2 (3.0)
7.7 ± 10.0 (4.0)
13
92.3%
23.1%
1.5 ± 1.7 (1.0)
1.5 ± 1.0 (1.0)
23416
9.2%
10.2%
9.0 ± 12.5 (5.0)
6.3 ± 9.4 (3.0)
OIS GRADE
N
1&2
14979
3
5288
4
2986
5
150
6
TOTAL
MORTALITY (%)
1. Mortality: OIS Grades 1 & 2 = OIS Grade 3 < OIS Grade 4 < OIS Grade 5 < OIS Grade 6.
2. OR: OIS Grade 1 & 2 = OIS Grade 3 < OIS Grade 4 = OIS Grade 5 = OIS Grade 6.
3. LOS: OIS Grade 6 < OIS Grade 1 & 2 = OIS Grade 3 = OIS Grade 4 = OIS Grade 5.
4. ICU LOS: OIS Grade 6 < OIS Grade 1 & 2 = OIS Grade 3 = OIS Grade 4 = OIS Grade 5.
National Trauma Data Bank (NTDB)
NTDB VERSION 8-11
© 2014 American College of Surgeons
OR G A N I N J URY S C AL E
L I V E R INJU RY
S PLE E N INJU RY
Liver Anatomy Overview
PAG E 2 2
I S O L AT E D LI V E R I N J U R I E S
W/O S E V E R E H E A D T R AU M A - M O R TA LIT Y
Liver Injury Scaling
Liver Injury Images
Isolated Liver Injury Statistics
Isolated Liver Injury without
Severe Head Trauma Statistics
M O R TA L I T Y
All Liver Injury Statistics
100%
90%
80%
70%
Isolated Liver Injury without
Severe Head Trauma or Early
Death ≤24 Hours Statistics
60%
50%
Liver Injuries-Mortality
40%
Liver Injuries-OR
Liver Injuries-LOS
30%
Liver Injuries-ICU
20%
10%
0%
1 & 2
3
4
5
6
TOTA L
OIS GRADE
NTDB VERSION 8-11
National Trauma Data Bank (NTDB)
© 2014 American College of Surgeons
OR G A N I N J URY S C AL E
L I V E R INJU RY
Liver Anatomy Overview
S PLE E N INJU RY
PAG E 2 3
I S O L AT E D LI V E R I N J U R I E S
W/O S E V E R E H E A D T R AU M A - O P E R ATI N G R O O M
Liver Injury Scaling
Liver Injury Images
OR
All Liver Injury Statistics
Isolated Liver Injury Statistics
30%
Isolated Liver Injury without
Severe Head Trauma Statistics
25%
Isolated Liver Injury without
Severe Head Trauma or Early
Death ≤24 Hours Statistics
20%
15%
Liver Injuries-Mortality
Liver Injuries-OR
10%
Liver Injuries-LOS
Liver Injuries-ICU
5%
0%
1 & 2
3
4
5
6
TOTA L
OIS GRADE
NTDB VERSION 8-11
National Trauma Data Bank (NTDB)
© 2014 American College of Surgeons
OR G A N I N J URY S C AL E
L I V E R INJU RY
S PLE E N INJU RY
Liver Anatomy Overview
PAGE 24
I S O L AT E D LI V E R I N J U R I E S
W/O S E V E R E H E A D T R AU M A - LO S
Liver Injury Scaling
Liver Injury Images
LOS
All Liver Injury Statistics
Isolated Liver Injury Statistics
12
Isolated Liver Injury without
Severe Head Trauma Statistics
10
Isolated Liver Injury without
Severe Head Trauma or Early
Death ≤24 Hours Statistics
8
6
Liver Injuries-Mortality
Liver Injuries-OR
4
Liver Injuries-LOS
Liver Injuries-ICU
2
0
1 & 2
3
4
5
6
TOTA L
OIS GRADE
NTDB VERSION 8-11
National Trauma Data Bank (NTDB)
© 2014 American College of Surgeons
OR G A N I N J URY S C AL E
L I V E R INJU RY
S PLE E N INJU RY
PAG E 2 5
I S O L AT E D LI V E R I N J U R I E S
W/O S E V E R E H E A D T R AU M A - I C U
Liver Anatomy Overview
ICU
Liver Injury Scaling
Liver Injury Images
9
8
All Liver Injury Statistics
7
Isolated Liver Injury Statistics
6
Isolated Liver Injury without
Severe Head Trauma Statistics
5
Isolated Liver Injury without
Severe Head Trauma or Early
Death ≤24 Hours Statistics
4
3
Liver Injuries-Mortality
2
Liver Injuries-OR
1
Liver Injuries-LOS
0
Liver Injuries-ICU
1 & 2
3
4
5
6
TOTA L
OIS GRADE
LOS (DAYS)
MEAN ± SD (MEDIAN)
ICU (DAYS)
MEAN ± SAD (MEDIAN)
7.3%
7.8 ± 10.7 (5.0)
5.7 ± 8.9 (3.0)
12.3%
8.2 ± 10.2 (5.0)
5.0 ± 7.3 (2.0)
OIS GRADE
N
MORTALITY (%)
OR (%)
1&2
13216
4.9%
3
4812
4.6%
4
2696
17.9%
24.8%
10.6 ± 14.6 (6.0)
7.0 ± 10.9 (3.0)
5
129
46.5%
26.5%
9.8 ± 16.8 (3.5)
7.8 ± 10.4 (4.0)
6
12
91.7%
25.0%
1.6 ± 1.7 (1.0)
1.5 ± 1.0 (1.0)
TOTAL
20865
6.9%
10.8%
8.3 ± 11.3 (5.0)
5.7 ± 8.9 (3.0)
1. Mortality: OIS Grades 1 & 2 = OIS Grade 3 < OIS Grade 4 < OIS Grade 5 < OIS Grade 6.
2. OR: OIS Grade 1 & 2 = OIS Grade 3 < OIS Grade 4 = OIS Grade 5 = OIS Grade 6.
3. LOS: OIS Grades 6 < OIS Grades 1&2 = OIS Grade 3 = OIS Grade 4 = OIS Grade 5.
4. ICU LOS: OIS Grades 6 < OIS Grades 1&2 = OIS Grade 3 = OIS Grade 4 = OIS Grade 5.
National Trauma Data Bank (NTDB)
NTDB VERSION 8-11
© 2014 American College of Surgeons
OR G A N I N J URY S C AL E
Liver Anatomy Overview
Liver Injury Scaling
L I V E R INJU RY
S PLE E N INJU RY
PAG E 2 6
I S O L AT E D LI V E R I N J U R I E S W/O S E V E R E H E A D T R AU M A
O R E A R LY D E AT H
2 4 H O U R S - M O R TA LIT Y
Liver Injury Images
M O R TA L I T Y
All Liver Injury Statistics
Isolated Liver Injury Statistics
Isolated Liver Injury without
Severe Head Trauma Statistics
Isolated Liver Injury without
Severe Head Trauma or Early
Death ≤24 Hours Statistics
60%
50%
40%
30%
Liver Injuries-Mortality
Liver Injuries-OR
Liver Injuries-LOS
20%
Liver Injuries-ICU
10%
0%
1 & 2
3
4
5
6
TOTA L
OIS GRADE
NTDB VERSION 8-11
National Trauma Data Bank (NTDB)
© 2014 American College of Surgeons
OR G A N I N J URY S C AL E
Liver Anatomy Overview
Liver Injury Scaling
L I V E R INJU RY
S PLE E N INJU RY
PAGE 27
I S O L AT E D LI V E R I N J U R I E S W/O S E V E R E H E A D T R AU M A
O R E A R LY D E AT H
2 4 H O U R S - O P E R ATI N G R O O M
Liver Injury Images
Isolated Liver Injury Statistics
OR
All Liver Injury Statistics
25%
Isolated Liver Injury without
Severe Head Trauma Statistics
20%
Isolated Liver Injury without
Severe Head Trauma or Early
Death ≤24 Hours Statistics
15%
Liver Injuries-Mortality
Liver Injuries-OR
10%
Liver Injuries-LOS
Liver Injuries-ICU
5%
0%
1 & 2
3
4
5
6
TOTA L
OIS GRADE
NTDB VERSION 8-11
National Trauma Data Bank (NTDB)
© 2014 American College of Surgeons
OR G A N I N J URY S C AL E
Liver Anatomy Overview
Liver Injury Scaling
L I V E R INJU RY
S PLE E N INJU RY
PAG E 2 8
I S O L AT E D LI V E R I N J U R I E S W/O S E V E R E H E A D T R AU M A
O R E A R LY D E AT H
2 4 H O U R S - LO S
Liver Injury Images
Isolated Liver Injury Statistics
Isolated Liver Injury without
Severe Head Trauma Statistics
L O S ( DAYS )
All Liver Injury Statistics
Isolated Liver Injury without
Severe Head Trauma or Early
Death ≤24 Hours Statistics
18
16
14
12
10
Liver Injuries-Mortality
8
Liver Injuries-OR
6
Liver Injuries-LOS
4
Liver Injuries-ICU
2
0
1 & 2
3
4
5
6
TOTA L
OIS GRADE
NTDB VERSION 8-11
National Trauma Data Bank (NTDB)
© 2014 American College of Surgeons
OR G A N I N J URY S C AL E
L I V E R INJU RY
S PLE E N INJU RY
PAG E 2 9
I S O L AT E D LI V E R I N J U R I E S W/O S E V E R E H E A D T R AU M A
O R E A R LY D E AT H
24 HOURS - ICU
Liver Anatomy Overview
I C U ( DAYS )
Liver Injury Scaling
Liver Injury Images
All Liver Injury Statistics
Isolated Liver Injury Statistics
10
9
8
7
Isolated Liver Injury without
Severe Head Trauma Statistics
6
5
Isolated Liver Injury without
Severe Head Trauma or Early
Death ≤24 Hours Statistics
4
3
2
Liver Injuries-Mortality
Liver Injuries-OR
1
Liver Injuries-LOS
0
1 & 2
Liver Injuries-ICU
OIS GRADE
3
4
5
6
TOTA L
OIS GRADE
OR (%)
LOS (DAYS)
MEAN ± SD (MEDIAN)
ICU (DAYS)
MEAN ± SD (MEDIAN)
1.9%
7.1%
8.0 ± 10.8 (5.0)
5.7 ± 9.0 (3.0)
1.5%
12.0%
8.4 ± 10.3 (5.0)
5.0 ± 7.3 (2.0)
N
MORTALITY (%)
1&2
12811
3
4662
4
2292
3.4%
23.3%
12.2 ± 15.2 (7.0)
7.3 ± 11.1 (3.0)
5
73
5.5%
20.0%
16.0 ± 19.7 (1.0)
8.9 ± 10.8 (4.0)
6
2
50.0%
0%
1.5 ± 3.5 (4.5)
2.0 ± 1.4 (2.0)
TOTAL
19840
2.0%
10.2%
8.6 ± 11.4 (5.0)
5.8 ± 9.0 (3.0)
1. Mortality: OIS Grades 6 > OIS Grades 1 & 2 = OIS Grade 3 = OIS Grade 4 = OIS Grade 5.
2. OR: OIS Grade 1 & 2 < OIS Grade 3 < OIS Grade 4 = OIS Grade 5.
3. LOS: Equivalent (p = 0.169).
4. ICU LOS: Equivalent (p = 0.445).
- AIS 90 codes: {541899.2, 541810.2, 541812.2, 541820.2, 541822.2, 541814.3, 541824.3, 541826.4, 541828.5, 541830.6}
- Operative procedures related to the liver injury ICD-9 codes: 50.00-50.99.
- Significance level set at α < 0.025.
National Trauma Data Bank (NTDB)
NTDB VERSION 8-11
© 2014 American College of Surgeons
OR G A N I N J URY S C AL E
L I V E R INJU RY
SP LE E N IN JU RY
PAGE 3 0
AUTHO RS
• The American College of Surgeons
Committee on Trauma
• American Association for the
Surgery of Trauma
• Glen H. Tinkoff, MD, FACS
• Thomas J. Esposito, MD, FACS
• Stanford M. Goldman, MD
• O. Clark West, MD
• Michael McGonigal, MD, FACS
• Paul R. G. Cunningham, MB, BS, FACS
• John Fields, MD, FACS
• Henri Ford, MD, FACS
• Dennis W. Ashley, MD, FACS
This publication is designed to offer information suitable for use by an appropriately trained physician.
The information provided is not intended to be comprehensive or to offer a defined standard of care.
The user agrees to release and idemnify the American College of Surgeons from claims arising from use of the publication.
© 2014 American College of Surgeons
OR G A N I N J URY S C AL E
L I V E R INJU RY
S PLE E N INJU RY
PAGE 3 1
Spleen Injury Scaling
Spleen Injury Images
All Spleen Injury Statistics
Isolated Spleen Injury Statistics
Isolated Spleen Injury without
Severe Head Trauma Statistics
Isolated Spleen Injury without
Severe Head Trauma or Early
Death ≤24 Hours Statistics
GRADE*
ICD ‑9
AIS ‑90
➊
Subcapsular hematoma, <10% surface area; capsular tear, <1 cm
parenchymal depth
865.01
865.11
865.02
865.12
2
➋
Subcapsular hematoma, 10%‑50% surface area; intraparenchymal, <5 cm in diameter;
laceration 1‑3 cm parenchymal depth, <10 cm in length which does not involve a
trabecular vessel
865.01
865.11
865.03
865.13
2
➌
Subcapsular hematoma, >50% surface area or expanding; ruptured subcapsular or
parenchymal hematoma; intraparenchymal hematoma >5 cm or expanding;
laceration >3 cm parenchymal depth or involving trabecular vessels
865.03
865.13
3
➍
Laceration involving segmental or hilar vessels producing major devascularization
(>25% of spleen)
➎
Completely shattered spleen; hilar vascular injury which devascularizes spleen
NTDB* Spleen Injury Mortality Rates
I N J U RY D E S C R I P TI O N
4
865.04
865.14
5
➌
*Advance one grade for multiple injuries, up to grade
From Moore EE, Cogbill TH,
Jurkovich GJ, et al. Organ injury scaling V: Spleen and liver (1994 revision).
J Trauma. 1995;38:323. With permission.
National Trauma Data Bank (NTDB)
© 2014 American College of Surgeons
OR G A N I N J URY S C AL E
L I V E R INJU RY
S PLE E N INJU RY
PAGE
3 2 43
page
32 of
Spleen Injury Scaling
Spleen Injury Images
All Spleen Injury Statistics
Isolated Spleen Injury Statistics
Isolated Spleen Injury without
Severe Head Trauma Statistics
Isolated Spleen Injury without
Severe Head Trauma or Early
Death ≤24 Hours Statistics
GRADE
➊
I N J U RY D E S C R I P TI O N
Subcapsular hematoma, <10% surface area; capsular tear, <1 cm parenchymal depth
National Trauma Data Bank (NTDB)
ICD -9
AIS 90
865.01
865.11
865.02
865.12
2
© 2014 American College of Surgeons
OR G A N I N J URY S C AL E
L I V E R INJU RY
S PLE E N INJU RY
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3 3 43
page
33 of
Spleen Injury Scaling
Spleen Injury Images
All Spleen Injury Statistics
Isolated Spleen Injury Statistics
Isolated Spleen Injury without
Severe Head Trauma Statistics
Isolated Spleen Injury without
Severe Head Trauma or Early
Death ≤24 Hours Statistics
GRADE
➊
I N J U RY D E S C R I P TI O N
Subcapsular hematoma, <10% surface area; capsular tear, <1 cm parenchymal depth
National Trauma Data Bank (NTDB)
ICD -9
AIS 90
865.01
865.11
865.02
865.12
2
© 2014 American College of Surgeons
OR G A N I N J URY S C AL E
L I V E R INJU RY
S PLE E N INJU RY
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3 443
page
Spleen Injury Scaling
Spleen Injury Images
All Spleen Injury Statistics
Isolated Spleen Injury Statistics
Isolated Spleen Injury without
Severe Head Trauma Statistics
Isolated Spleen Injury without
Severe Head Trauma or Early
Death ≤24 Hours Statistics
GRADE
➋
I N J U RY D E S C R I P TI O N
Subcapsular hematoma, 105‑50% surface area; intraparenchymal, <5 cm in diameter;
laceration 1‑3 cm parenchymal depth, <10 cm in length which does not involve a
trabecular vessel
National Trauma Data Bank (NTDB)
ICD -9
AIS 90
865.01
865.11
865.03
865.13
2
© 2014 American College of Surgeons
OR G A N I N J URY S C AL E
L I V E R INJU RY
S PLE E N INJU RY
PAGE
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page
35 of
Spleen Injury Scaling
Spleen Injury Images
All Spleen Injury Statistics
Isolated Spleen Injury Statistics
Isolated Spleen Injury without
Severe Head Trauma Statistics
Isolated Spleen Injury without
Severe Head Trauma or Early
Death ≤24 Hours Statistics
GRADE
➋
I N J U RY D E S C R I P TI O N
Subcapsular hematoma, 10%‑50% surface area; intraparenchymal, <5 cm in diameter;
laceration 1‑3 cm parenchymal depth, <10 cm in length which does not involve a
trabecular vessel
National Trauma Data Bank (NTDB)
ICD -9
AIS 90
865.01
865.11
865.03
865.13
2
© 2014 American College of Surgeons
OR G A N I N J URY S C AL E
L I V E R INJU RY
S PLE E N INJU RY
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page
36 of
Spleen Injury Scaling
Spleen Injury Images
All Spleen Injury Statistics
Isolated Spleen Injury Statistics
Isolated Spleen Injury without
Severe Head Trauma Statistics
Isolated Spleen Injury without
Severe Head Trauma or Early
Death ≤24 Hours Statistics
GRADE
➌
I N J U RY D E S C R I P TI O N
Subcapsular hematoma, >50% surface area or expanding; ruptured subcapsular or
parenchymal hematoma; intraparenchymal hematoma >5 cm or expanding;
laceration >3 cm parenchymal depth or involving trabecular vessels
National Trauma Data Bank (NTDB)
ICD -9
AIS 90
865.03
865.13
3
© 2014 American College of Surgeons
OR G A N I N J URY S C AL E
L I V E R INJU RY
S PLE E N INJU RY
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Spleen Injury Scaling
Spleen Injury Images
All Spleen Injury Statistics
Isolated Spleen Injury Statistics
Isolated Spleen Injury without
Severe Head Trauma Statistics
Isolated Spleen Injury without
Severe Head Trauma or Early
Death ≤24 Hours Statistics
GRADE
➌
I N J U RY D E S C R I P TI O N
Subcapsular hematoma, >50% surface area or expanding; ruptured subcapsular or
parenchymal hematoma; intraparenchymal hematoma >5 cm or expanding; laceration
>3 cm parenchymal depth or involv
ing trabecular vessels
National Trauma Data Bank (NTDB)
ICD -9
AIS 90
865.03
865.13
3
© 2014 American College of Surgeons
OR G A N I N J URY S C AL E
L I V E R INJU RY
S PLE E N INJU RY
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page
38 of
Spleen Injury Scaling
Spleen Injury Images
All Spleen Injury Statistics
Isolated Spleen Injury Statistics
Isolated Spleen Injury without
Severe Head Trauma Statistics
Isolated Spleen Injury without
Severe Head Trauma or Early
Death ≤24 Hours Statistics
( W IT H E X T R AVA SATI O N)
GRADE
➍
I N J U RY D E S C R I P TI O N
Laceration involving segmental or hilar vessels producing major
devascularization (>25% of spleen)
National Trauma Data Bank (NTDB)
ICD -9
AIS 90
4
© 2014 American College of Surgeons
OR G A N I N J URY S C AL E
L I V E R INJU RY
S PLE E N INJU RY
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page
Spleen Injury Scaling
Spleen Injury Images
All Spleen Injury Statistics
Isolated Spleen Injury Statistics
Isolated Spleen Injury without
Severe Head Trauma Statistics
Isolated Spleen Injury without
Severe Head Trauma or Early
Death ≤24 Hours Statistics
( W IT H O U T E X T R AVA SATI O N)
GRADE
➍
I N J U RY D E S C R I P TI O N
Laceration involving segmental or hilar vessels producing major
devascularization (>25% of spleen)
National Trauma Data Bank (NTDB)
ICD -9
AIS 90
4
© 2014 American College of Surgeons
OR G A N I N J URY S C AL E
L I V E R INJU RY
S PLE E N INJU RY
PAG40
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of043
Spleen Injury Scaling
Spleen Injury Images
All Spleen Injury Statistics
Isolated Spleen Injury Statistics
Isolated Spleen Injury without
Severe Head Trauma Statistics
Isolated Spleen Injury without
Severe Head Trauma or Early
Death ≤24 Hours Statistics
GRADE
➍
I N J U RY D E S C R I P TI O N
Laceration involving segmental or hilar vessels producing major devascularization
(>25% of spleen)
National Trauma Data Bank (NTDB)
ICD -9
AIS 90
4
© 2014 American College of Surgeons
OR G A N I N J URY S C AL E
L I V E R INJU RY
S PLE E N INJU RY
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Spleen Injury Scaling
Spleen Injury Images
All Spleen Injury Statistics
Isolated Spleen Injury Statistics
Isolated Spleen Injury without
Severe Head Trauma Statistics
Isolated Spleen Injury without
Severe Head Trauma or Early
Death ≤24 Hours Statistics
GRADE
➎
I N J U RY D E S C R I P TI O N
Completely shattered spleen; hilar vascular injury which devascularizes spleen
National Trauma Data Bank (NTDB)
ICD -9
AIS 90
865.04
865.14
5
© 2014 American College of Surgeons
OR G A N I N J URY S C AL E
L I V E R INJU RY
S PLE E N INJU RY
PAGE 4 2
Spleen Anatomy
Spleen Injury Scaling
S P L E E N I N J U R I E S – M O R TA LIT Y
Spleen Injury Images
Isolated Spleen Injury Statistics
Isolated Spleen Injury without
Severe Head Trauma Statistics
Isolated Spleen Injury without
Severe Head Trauma or Early
Death ≤24 Hours Statistics
M O R TA L I T Y
All Spleen Injury Statistics
20%
15%
10%
Spleen Injuries-Mortality
Spleen Injuries-OR
Spleen Injuries-LOS
5%
Spleen Injuries-ICU
0%
1 & 2
3
4
5
TOTA L
OIS GRADE
NTDB VERSION 8-11
National Trauma Data Bank (NTDB)
© 2014 American College of Surgeons
OR G A N I N J URY S C AL E
L I V E R INJU RY
S PLE E N INJU RY
PAG E 4 3
Spleen Anatomy
Spleen Injury Scaling
S P L E E N I N J U R I E S – O P E R ATI N G R O O M
All Spleen Injury Statistics
OR
Spleen Injury Images
70%
Isolated Spleen Injury Statistics
60%
Isolated Spleen Injury without
Severe Head Trauma Statistics
50%
Isolated Spleen Injury without
Severe Head Trauma or Early
Death ≤24 Hours Statistics
40%
30%
Spleen Injuries-Mortality
Spleen Injuries-OR
20%
Spleen Injuries-LOS
Spleen Injuries-ICU
10%
0%
1 & 2
3
4
5
TOTA L
OIS GRADE
NTDB VERSION 8-11
National Trauma Data Bank (NTDB)
© 2014 American College of Surgeons
OR G A N I N J URY S C AL E
L I V E R INJU RY
S PLE E N INJU RY
PAGE 4 4
Spleen Anatomy
Spleen Injury Scaling
S P L E E N I N J U R I E S – LO S
Spleen Injury Images
Isolated Spleen Injury Statistics
Isolated Spleen Injury without
Severe Head Trauma Statistics
Isolated Spleen Injury without
Severe Head Trauma or Early
Death ≤24 Hours Statistics
L O S ( DAYS )
All Spleen Injury Statistics
14
12
10
8
Spleen Injuries-Mortality
6
Spleen Injuries-OR
4
Spleen Injuries-LOS
Spleen Injuries-ICU
2
0
1 & 2
3
4
5
TOTA L
OIS GRADE
NTDB VERSION 8-11
National Trauma Data Bank (NTDB)
© 2014 American College of Surgeons
OR G A N I N J URY S C AL E
L I V E R INJU RY
S PLE E N INJU RY
Spleen Anatomy
PAG E 4 5
SPLEEN INJURIES – ICU
Spleen Injury Scaling
I C U ( DAYS )
Spleen Injury Images
All Spleen Injury Statistics
Isolated Spleen Injury Statistics
Isolated Spleen Injury without
Severe Head Trauma Statistics
9
8
7
6
Isolated Spleen Injury without
Severe Head Trauma or Early
Death ≤24 Hours Statistics
5
4
3
2
Spleen Injuries-Mortality
Spleen Injuries-OR
1
Spleen Injuries-LOS
0
1 & 2
Spleen Injuries-ICU
3
4
5
TOTA L
OIS GRADE
OIS GRADE
N
MORTALITY (%)
1&2
18617
7.4%
3
2902
5.6%
LOS (DAYS)
MEAN ± SD (MEDIAN)
ICU (DAYS)
MEAN ± SD (MEDIAN)
11.3%
10.3 ± 13.5 (5.0)
6.9 ± 9.6 (3.0)
16.7%
10.5 ± 13.9 (5.0)
6.3 ± 9.4 (2.0)
OR (%)
4
8553
8.7%
29.7%
10.5 ± 13.7 (7.0)
6.7 ± 10.2 (3.0)
5
4290
16.0%
60.0%
12.2 ± 15.8 (1.0)
7.8 ± 11.6 (4.0)
TOTAL
31389
8.7%
22.4%
10.6 ± 13.9 (5.0)
7.0 ± 10.0 (3.0)
1. Mortality: OIS Grade 3 < OIS Grade 1 & 2 = OIS Grade 4 < OIS Grade 5.
2. OR: OIS Grades 1 & 2 < OIS Grade 3 < OIS Grade 4 < OIS Grade 5.
3. LOS: OIS Grades 1&2 = OIS Grade 3 = OIS Grade 4 < OIS Grade 5.
4. ICU LOS: OIS Grade 3 < OIS Grade 4 = OIS Grade 1 & 2 < OIS Grade 5.
National Trauma Data Bank (NTDB)
NTDB VERSION 8-11
© 2014 American College of Surgeons
OR G A N I N J URY S C AL E
L I V E R INJU RY
S PLE E N INJU RY
PAGE 4 6
Spleen Anatomy
Spleen Injury Scaling
I S O L AT E D S P L E E N I N J U R I E S – M O R TA LIT Y
Spleen Injury Images
All Spleen Injury Statistics
M O R TA L I T Y
Isolated Spleen Injury Statistics
Isolated Spleen Injury without
Severe Head Trauma Statistics
Isolated Spleen Injury without
Severe Head Trauma or Early
Death ≤24 Hours Statistics
15%
10%
Spleen Injuries-Mortality
Spleen Injuries-OR
5%
Spleen Injuries-LOS
Spleen Injuries-ICU
0%
1 & 2
3
4
5
TOTA L
OIS GRADE
NTDB VERSION 8-11
National Trauma Data Bank (NTDB)
© 2014 American College of Surgeons
OR G A N I N J URY S C AL E
L I V E R INJU RY
S PLE E N INJU RY
PAG E 47
Spleen Anatomy
Spleen Injury Scaling
I S O L AT E D S P L E E N I N J U R I E S – O P E R ATI N G R O O M
Spleen Injury Images
All Spleen Injury Statistics
OR
Isolated Spleen Injury Statistics
Isolated Spleen Injury without
Severe Head Trauma Statistics
60%
50%
Isolated Spleen Injury without
Severe Head Trauma or Early
Death ≤24 Hours Statistics
40%
30%
Spleen Injuries-Mortality
Spleen Injuries-OR
20%
Spleen Injuries-LOS
Spleen Injuries-ICU
10%
0%
1 & 2
3
4
5
TOTA L
OIS GRADE
NTDB VERSION 8-11
National Trauma Data Bank (NTDB)
© 2014 American College of Surgeons
OR G A N I N J URY S C AL E
L I V E R INJU RY
S PLE E N INJU RY
PAG E 4 8
Spleen Anatomy
Spleen Injury Scaling
I S O L AT E D S P L E E N I N J U R I E S - LO S
Spleen Injury Images
All Spleen Injury Statistics
L O S ( DAYS )
Isolated Spleen Injury Statistics
Isolated Spleen Injury without
Severe Head Trauma Statistics
Isolated Spleen Injury without
Severe Head Trauma or Early
Death ≤24 Hours Statistics
12
10
8
6
Spleen Injuries-Mortality
Spleen Injuries-OR
4
Spleen Injuries-LOS
Spleen Injuries-ICU
2
0
1 & 2
3
4
5
TOTA L
OIS GRADE
NTDB VERSION 8-11
National Trauma Data Bank (NTDB)
© 2014 American College of Surgeons
OR G A N I N J URY S C AL E
L I V E R INJU RY
S PLE E N INJU RY
PAGE 49
Spleen Anatomy
Spleen Injury Scaling
I S O L AT E D S P L E E N I N J U R I E S - I C U
I C U ( DAYS )
Spleen Injury Images
All Spleen Injury Statistics
Isolated Spleen Injury Statistics
Isolated Spleen Injury without
Severe Head Trauma Statistics
7
6
5
Isolated Spleen Injury without
Severe Head Trauma or Early
Death ≤24 Hours Statistics
4
3
2
Spleen Injuries-Mortality
Spleen Injuries-OR
1
Spleen Injuries-LOS
Spleen Injuries-ICU
0
1 & 2
3
4
5
TOTA L
OIS GRADE
LOS (DAYS)
MEAN ± SD (MEDIAN)
ICU (DAYS)
MEAN ± SD (MEDIAN)
9.20%
9.1
6.2
13.70%
8.8
5.4
25.00%
9.1
5.6
10.90%
56.00%
10.3
6.5
6.00%
19.10%
9.2
6
OIS GRADE
N
MORTALITY (%)
1&2
12937
5.40%
3
2033
3.50%
4
5946
5.70%
5
2759
TOTAL
23675
1. Mortality: OIS Grade 3 < OIS Grade 1 & 2 = OIS Grade 4 < OIS Grade 5.
2. OR: OIS Grade 1 & 2 < OIS Grade 3 < OIS Grade 4 < OIS Grade 5.
3. LOS: OIS Grade 1 & 2 = OIS Grade 3 = OIS Grade 4 < OIS Grade 5.
4. ICU LOS: OIS Grade 3 = OIS Grade 4 < OIS Grade 1 & 2 = OIS Grade 5.
National Trauma Data Bank (NTDB)
OR (%)
NTDB VERSION 8-11
© 2014 American College of Surgeons
OR G A N I N J URY S C AL E
L I V E R INJU RY
S PLE E N INJU RY
PAGE 5 0
Spleen Anatomy
I S O L AT E D S P L E E N I N J U R I E S W/O
S E V E R E H E A D T R AU M A - M O R TA LIT Y
Spleen Injury Scaling
Spleen Injury Images
All Spleen Injury Statistics
M O R TA L I T Y
Isolated Spleen Injury Statistics
Isolated Spleen Injury without
Severe Head Trauma Statistics
Isolated Spleen Injury without
Severe Head Trauma or Early
Death ≤24 Hours Statistics
10%
8%
6%
4%
Spleen Injuries-Mortality
Spleen Injuries-OR
2%
Spleen Injuries-LOS
Spleen Injuries-ICU
0%
1 & 2
3
4
5
TOTA L
OIS GRADE
NTDB VERSION 8-11
National Trauma Data Bank (NTDB)
© 2014 American College of Surgeons
OR G A N I N J URY S C AL E
L I V E R INJU RY
S PLE E N INJU RY
PAG E 5 1
Spleen Anatomy
I S O L AT E D S P L E E N I N J U R I E S W/O
S E V E R E H E A D T R AU M A - O P E R ATI N G R O O M
Spleen Injury Scaling
Spleen Injury Images
All Spleen Injury Statistics
OR
Isolated Spleen Injury Statistics
Isolated Spleen Injury without
Severe Head Trauma Statistics
60%
50%
Isolated Spleen Injury without
Severe Head Trauma or Early
Death ≤24 Hours Statistics
40%
30%
Spleen Injuries-Mortality
20%
Spleen Injuries-OR
10%
Spleen Injuries-LOS
Spleen Injuries-ICU
0%
1 & 2
3
4
5
TOTA L
OIS GRADE
NTDB VERSION 8-11
National Trauma Data Bank (NTDB)
© 2014 American College of Surgeons
OR G A N I N J URY S C AL E
L I V E R INJU RY
S PLE E N INJU RY
PAG E 52
Spleen Anatomy
I S O L AT E D S P L E E N I N J U R I E S W/O
S E V E R E H E A D T R AU M A - LO S
Spleen Injury Scaling
Spleen Injury Images
All Spleen Injury Statistics
L O S ( DAY )
Isolated Spleen Injury Statistics
Isolated Spleen Injury without
Severe Head Trauma Statistics
Isolated Spleen Injury without
Severe Head Trauma or Early
Death ≤24 Hours Statistics
12
10
8
6
Spleen Injuries-Mortality
4
Spleen Injuries-OR
2
Spleen Injuries-LOS
Spleen Injuries-ICU
0
1 & 2
3
4
5
TOTA L
OIS GRADE
NTDB VERSION 8-11
National Trauma Data Bank (NTDB)
© 2014 American College of Surgeons
OR G A N I N J URY S C AL E
L I V E R INJU RY
S PLE E N INJU RY
PAGE 53
Spleen Anatomy
I S O L AT E D S P L E E N I N J U R I E S W/O
S E V E R E H E A D T R AU M A - I C U
Spleen Injury Scaling
Spleen Injury Images
ICU
All Spleen Injury Statistics
Isolated Spleen Injury Statistics
7
6
Isolated Spleen Injury without
Severe Head Trauma Statistics
5
Isolated Spleen Injury without
Severe Head Trauma or Early
Death ≤24 Hours Statistics
4
3
2
Spleen Injuries-Mortality
1
Spleen Injuries-OR
Spleen Injuries-LOS
0
1 & 2
Spleen Injuries-ICU
3
4
5
TOTA L
OIS GRADE
OIS GRADE
N
MORTALITY (%)
OR (%)
LOS (DAYS)
MEAN ± SD (MEDIAN)
ICU (DAYS)
MEAN ± SD (MEDIAN)
1&2
11369
2.9%
9.2%
8.1 ± 10.2 (7.0)
5.5 ± 8.5 (2.0)
3
1833
1.6%
13.7%
7.7 ± 8.4 (6.0)
4.4 ± 7.0 (2.0)
4
5411
3.7%
24.1%
8.4 ± 10.4 (6.0)
5.0 ± 8.3 (3.0)
5
2472
8.5%
55.0%
9.6 ± 11.8 (7.0)
5.9 ± 9.9 (3.0)
TOTAL
21085
3.6%
18.9%
8.3 ± 10.3 (7.0)
5.3 ± 8.6 (3.0)
1. Mortality: OIS Grade 3 < OIS Grade 1 & 2 = OIS Grade 4 < OIS Grade 5.
2. OR: OIS Grade 1 & 2 < OIS Grade 3 < OIS Grade 4 < OIS Grade 5.
3. LOS: OIS Grade 1 & 2 = OIS Grade 3 < OIS Grade 4 < OIS Grade 5.
4. ICU LOS: OIS Grade 3 < OIS Grade 4 = OIS Grade 1 & 2 < OIS Grade
NTDB VERSION 8-11
National Trauma Data Bank (NTDB)
© 2014 American College of Surgeons
OR G A N I N J URY S C AL E
L I V E R INJU RY
S PLE E N INJU RY
PAG E 5 4
Spleen Anatomy
Spleen Injury Scaling
Spleen Injury Images
I S O L AT E D S P L E E N I N J U R I E S W/O S E V E R E H E A D T R AU M A
O R E A R LY D E AT H
2 4 H O U R S - M O R TA LIT Y
All Spleen Injury Statistics
M O R TA L I T Y
Isolated Spleen Injury Statistics
Isolated Spleen Injury without
Severe Head Trauma Statistics
Isolated Spleen Injury without
Severe Head Trauma or Early
Death ≤24 Hours Statistics
4%
3.5%
3%
2.5%
2%
1.5%
Spleen Injuries-Mortality
Spleen Injuries-OR
1%
Spleen Injuries-LOS
0.5%
Spleen Injuries-ICU
0%
1 & 2
3
4
5
TOTA L
OIS GRADE
NTDB VERSION 8-11
National Trauma Data Bank (NTDB)
© 2014 American College of Surgeons
OR G A N I N J URY S C AL E
L I V E R INJU RY
S PLE E N INJU RY
PAG E 5 5
Spleen Anatomy
Spleen Injury Scaling
Spleen Injury Images
I S O L AT E D S P L E E N I N J U R I E S W/O S E V E R E H E A D T R AU M A
O R E A R LY D E AT H
2 4 H O U R S - O P E R ATI N G R O O M
All Spleen Injury Statistics
OR
Isolated Spleen Injury Statistics
Isolated Spleen Injury without
Severe Head Trauma Statistics
60%
50%
Isolated Spleen Injury without
Severe Head Trauma or Early
Death ≤24 Hours Statistics
40%
30%
20%
Spleen Injuries-Mortality
Spleen Injuries-OR
10%
Spleen Injuries-LOS
Spleen Injuries-ICU
0%
1 & 2
3
4
5
TOTA L
OIS GRADE
NTDB VERSION 8-11
National Trauma Data Bank (NTDB)
© 2014 American College of Surgeons
OR G A N I N J URY S C AL E
L I V E R INJU RY
S PLE E N INJU RY
PAGE 5 6
Spleen Anatomy
Spleen Injury Scaling
Spleen Injury Images
I S O L AT E D S P L E E N I N J U R I E S W/O S E V E R E H E A D T R AU M A
O R E A R LY D E AT H
2 4 H O U R S - LO S
All Spleen Injury Statistics
L O S ( DAYS )
Isolated Spleen Injury Statistics
Isolated Spleen Injury without
Severe Head Trauma Statistics
Isolated Spleen Injury without
Severe Head Trauma or Early
Death ≤24 Hours Statistics
12
10
8
6
4
Spleen Injuries-Mortality
Spleen Injuries-OR
2
Spleen Injuries-LOS
Spleen Injuries-ICU
0
1 & 2
3
4
5
TOTA L
OIS GRADE
NTDB VERSION 8-11
National Trauma Data Bank (NTDB)
© 2014 American College of Surgeons
OR G A N I N J URY S C AL E
L I V E R INJU RY
S PLE E N INJU RY
PAGE 57
Spleen Anatomy
I S O L AT E D S P L E E N I N J U R I E S W/O S E V E R E H E A D T R AU M A
O R E A R LY D E AT H
24 HOURS - ICU
Spleen Injury Scaling
Spleen Injury Images
I C U ( DAYS )
All Spleen Injury Statistics
Isolated Spleen Injury Statistics
Isolated Spleen Injury without
Severe Head Trauma Statistics
Isolated Spleen Injury without
Severe Head Trauma or Early
Death ≤24 Hours Statistics
7
6
5
4
3
2
Spleen Injuries-Mortality
1
Spleen Injuries-OR
0
Spleen Injuries-LOS
1 & 2
3
4
5
Spleen Injuries-ICU
TOTA L
OIS GRADE
OR (%)
LOS (DAYS)
MEAN ± SD (MEDIAN)
1.7%
8.9%
8.2 ± 10.6 (7.0)
5.5 ± 8.6 (2.0)
1.0%
13.3%
7.7 ± 8.4 (6.0)
4.4 ± 7.0 (2.0)
1.7%
23.6%
8.5 ± 10.4 (6.0)
5.1 ± 8.3 (3.0)
2349
3.7%
54.3%
10.1 ± 11.9 (7.0)
6.1 ± 10.0 (3.0)
20703
1.9%
18.3%
8.5 ± 10.4 (7.0)
5.4 ± 8.6 (3.0)
OIS GRADE
N
1&2
11229
3
1821
4
5304
5
TOTAL
MORTALITY (%)
1. Mortality: OIS Grade 1 & 2 = OIS Grade 3 = OIS Grade 4 < OIS Grade 5.
2. OR: OIS Grade 1 & 2 < OIS Grade 3 < OIS Grade 4 < OIS Grade 5.
3. LOS: OIS Grade 3 < OIS Grade 1 & 2 = OIS Grade 4 < OIS Grade 5.
4. ICU LOS: OIS Grade 3 < OIS Grade 4 = OIS Grades 1 & 2 < OIS Grade 5.
- AIS 90 codes: {544299.2, 544210.2, 544212.2, 544220.2, 544222.2, 544214.3, 544244.3, 544226.4, 544228.5}
- Operative procedures related to the spleen injury ICD-9 codes: 41.00-41.99.
- Significance level set at α < 0.025.
National Trauma Data Bank (NTDB)
ICU (DAYS)
MEAN ± SD (MEDIAN)
NTDB VERSION 8-11
© 2014 American College of Surgeons