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 20082012

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. 2014 American College of Surgeons
The user agrees to release and idemnify the American College of Surgeons from claims arising from use of the publication.
 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. 2014 American College of Surgeons
The user agrees to release and idemnify the American College of Surgeons from claims arising from use of the publication.
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

Liver Anatomy Overview

Liver Injury Scaling
Right Hemiliver (Right Liver) Left Hemiliver (Left Liver)
Liver Injury Images
Inferior Vena Cava Middle Heptic Vein
All Liver Injury Statistics
Right Heptic Vein Left Heptic Vein
Isolated Liver Injury Statistics

Isolated Liver Injury without 2

Severe Head Trauma Statistics
8
Isolated Liver Injury without

2006 WebMD Inc All rights reserved

Severe Head Trauma or Early 1, 9
Death 24 Hours Statistics 7

Falciform
Ligament
5
Portal Vein
6 Common
Heptic Artery

Common
Bile Duct

Right Posterior Right Anterior Left Medial Left Lateral

Section Section Section Section

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

Liver Anatomy Overview

Liver Injury Scaling

GRADE* I N J U RY D E S C R I P TI O N ICD -9 AIS 90
Liver Injury Images 864.01
All Liver Injury Statistics Subcapsular hematoma, <10% surface area; Capsular tear, <1 cm
parenchymal depth
864.11
864.02
864.12
2

Isolated Liver Injury Statistics

864.01
Isolated Liver Injury without
Severe Head Trauma Statistics Subcapsular hematoma, 10%-15% surface area; intraparenchymal, <10 cm in diameter;
laceration 1-3 cm parenchymal depth, <10 cm in length
864.11
864.03
864.13
2

Isolated Liver Injury without

Severe Head Trauma or Early Subcapsular hematoma, >50% surface area or expanding; ruptured subcapsular or
Death 24 Hours Statistics parenchymal hematoma; intraparenchymal hematoma >10 cm or expanding;
laceration >3 cm parenchymal depth
864.04
864.14
3

Parenchymal disruption involving 25% to 75% of hepatic lobe or 1-3 Couinauds

segments within a single lobe
864.04
864.14
4

Parenchymal disruption involving >75% of hepatic lobe or >3 Couinauds segments

within a single lobe; vascular juxtahepatic venous injuries; i.e., retrohepatic vena
cava/central major hepatic veins
5

Vascular hepatic avulsion 6

*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. 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

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 I N J U RY D E S C R I P TI O N ICD -9 AIS 90

864.01
Subcapsular hematoma, <10% surface area; capsular tear, 864.11
<1 cm parenchymal depth 864.02
864.12
2

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 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 I N J U RY D E S C R I P TI O N ICD -9 AIS 90

864.01
Subcapsular hematoma, <10% surface area; capsular tear, 864.11
<1 cm parenchymal depth 864.02
864.12
2

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 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 I N J U RY D E S C R I P TI O N ICD -9 AIS 90

864.01
Subcapsular hematoma, 10%-15% surface area; intraparenchymal, <10 cm in diameter; 864.11
laceration 1-3 cm parenchymal depth, <10 cm in length 864.03
864.13
2

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 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 I N J U RY D E S C R I P TI O N ICD -9 AIS 90

864.01
Subcapsular hematoma, 10%-15% surface area; intraparenchymal, 864.11
<10 cm in diameter; laceration 1-3 cm parenchymal depth, <10 cm in length 864.03
864.13
2

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 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 I N J U RY D E S C R I P TI O N ICD -9 AIS 90

Subcapsular hematoma, >50% surface area or expanding; ruptured subcapsular

864.04
or parenchymal hematoma; intraparenchymal hematoma >10 cm or expanding;
laceration >3 cm parenchymal depth
864.14
3

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 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 I N J U RY D E S C R I P TI O N ICD -9 AIS 90

Subcapsular hematoma, >50% surface area or expanding; ruptured subcapsular or

864.04
parenchymal hematoma; intraparenchymal hematoma >10 cm or expanding;
laceration >3 cm parenchymal depth
864.14
3

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 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 I N J U RY D E S C R I P TI O N ICD -9 AIS 90

Parenchymal disruption involving 25%-75% of hepatic lobe or 1-3 864.04

Couinauds segments within a single lobe 864.14
4

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 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 I N J U RY D E S C R I P TI O N ICD -9 AIS 90

Parenchymal disruption involving 25%-75% of hepatic lobe or 1-3 864.04

Couinauds segments within a single lobe 864.14
4

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 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 I N J U RY D E S C R I P TI O N ICD -9 AIS 90

Parenchymal disruption involving >75% of hepatic lobe or >3 Couinauds segments

within a single lobe; vascular juxtahepatic venous injuries; i.e., retrohepatic vena
cava/central major hepatic veins
5

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 4

Liver Anatomy Overview

Liver Injury Scaling LI V E R I N J U R I E S - M O R TA LIT Y

Liver Injury Images

All Liver Injury Statistics 100%

M O R TA L I T Y
Isolated Liver Injury Statistics

Isolated Liver Injury without 80%

Severe Head Trauma Statistics

Isolated Liver Injury without 60%

Severe Head Trauma or Early
Death 24 Hours Statistics

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

All Liver Injury Statistics

40%

OR
Isolated Liver Injury Statistics

Isolated Liver Injury without

Severe Head Trauma Statistics
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

14

L O S ( DAYS )
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 PAGE 1 7

LI V E R I N J U R I E S - I C U
Liver Anatomy Overview
12

I C U ( DAYS )
Liver Injury Scaling

Liver Injury Images

10

All Liver Injury Statistics

Isolated Liver Injury Statistics 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

LOS (DAYS) ICU (DAYS)

OIS GRADE N MORTALITY (%) OR (%)
MEAN SD (MEDIAN) MEAN SD (MEDIAN)
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. 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 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

All Liver Injury Statistics

100%

M O R TA L I T Y
Isolated Liver Injury Statistics
90%
Isolated Liver Injury without
Severe Head Trauma Statistics 80%

Isolated Liver Injury without 70%

Severe Head Trauma or Early
Death 24 Hours Statistics 60%

50%
Liver Injuries-Mortality
Liver Injuries-OR 40%

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 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

All Liver Injury Statistics

30%

OR
Isolated Liver Injury Statistics

Isolated Liver Injury without 25%

Severe Head Trauma Statistics

Isolated Liver Injury without

Severe Head Trauma or Early 20%
Death 24 Hours Statistics

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

All Liver Injury Statistics

12

L O S ( DAYS )
Isolated Liver Injury Statistics

Isolated Liver Injury without 10

Severe Head Trauma Statistics

Isolated Liver Injury without

8
Severe Head Trauma or Early
Death 24 Hours Statistics

6
Liver Injuries-Mortality
Liver Injuries-OR
Liver Injuries-LOS 4

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 2 1

I S O L AT E D LI V E R I N J U R I E S - I C U
Liver Anatomy Overview
9

I C U ( DAYS )
Liver Injury Scaling
8
Liver Injury Images

All Liver Injury Statistics 7

Isolated Liver Injury Statistics 6

Isolated Liver Injury without 5

Severe Head Trauma Statistics

Isolated Liver Injury without 4

Severe Head Trauma or Early
Death 24 Hours Statistics 3

Liver Injuries-Mortality 2

Liver Injuries-OR
1
Liver Injuries-LOS
Liver Injuries-ICU 0
1 & 2 3 4 5 6 TOTA L
OIS GRADE

LOS (DAYS) ICU (DAYS)

OIS GRADE N MORTALITY (%) OR (%)
MEAN SD (MEDIAN) MEAN SD (MEDIAN)
1&2 14979 7.5% 6.8% 8.7 12.2 (5.0) 6.4 9.5 (3.0)
3 5288 6.4% 11.7% 8.9 11.4 (5.0) 5.5 8.1 (2.0)
4 2986 20.6% 24.0% 10.9 15.0 (6.0) 7.3 10.9 (3.0)
5 150 48.7% 24.1% 9.5 16.2 (3.0) 7.7 10.0 (4.0)
6 13 92.3% 23.1% 1.5 1.7 (1.0) 1.5 1.0 (1.0)
TOTAL 23416 9.2% 10.2% 9.0 12.5 (5.0) 6.3 9.4 (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 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. 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 2

Liver Anatomy Overview

I S O L AT E D LI V E R I N J U R I E S
Liver Injury Scaling 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 Images

All Liver Injury Statistics

100%

M O R TA L I T Y
Isolated Liver Injury Statistics
90%
Isolated Liver Injury without
Severe Head Trauma Statistics 80%

Isolated Liver Injury without 70%

Severe Head Trauma or Early
Death 24 Hours Statistics 60%

50%
Liver Injuries-Mortality
40%
Liver Injuries-OR
30%
Liver Injuries-LOS
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 S PLE E N INJU RY PAG E 2 3

Liver Anatomy Overview

I S O L AT E D LI V E R I N J U R I E S
Liver Injury Scaling 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 Images

All Liver Injury Statistics

30%

OR
Isolated Liver Injury Statistics

Isolated Liver Injury without 25%

Severe Head Trauma Statistics

Isolated Liver Injury without 20%

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 L I V E R INJU RY S PLE E N INJU RY PAGE 24

Liver Anatomy Overview

I S O L AT E D LI V E R I N J U R I E S
Liver Injury Scaling W/O S E V E R E H E A D T R AU M A - LO S

Liver Injury Images

All Liver Injury Statistics

12

LOS
Isolated Liver Injury Statistics

Isolated Liver Injury without 10

Severe Head Trauma Statistics

Isolated Liver Injury without 8

Severe Head Trauma or Early
Death 24 Hours Statistics
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
Liver Anatomy Overview W/O S E V E R E H E A D T R AU M A - I C U

Liver Injury Scaling

9

ICU
Liver Injury Images
8
All Liver Injury Statistics
7
Isolated Liver Injury Statistics
6
Isolated Liver Injury without
Severe Head Trauma Statistics
5

Isolated Liver Injury without

4
Severe Head Trauma or Early
Death 24 Hours Statistics
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) ICU (DAYS)

OIS GRADE N MORTALITY (%) OR (%)
MEAN SD (MEDIAN) MEAN SAD (MEDIAN)
1&2 13216 4.9% 7.3% 7.8 10.7 (5.0) 5.7 8.9 (3.0)
3 4812 4.6% 12.3% 8.2 10.2 (5.0) 5.0 7.3 (2.0)
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. 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 6

Liver Anatomy Overview

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
Liver Injury Scaling 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

All Liver Injury Statistics

60%

M O R TA L I T Y
Isolated Liver Injury Statistics

Isolated Liver Injury without

Severe Head Trauma Statistics 50%

Isolated Liver Injury without

Severe Head Trauma or Early 40%
Death 24 Hours Statistics

Liver Injuries-Mortality 30%

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 L I V E R INJU RY S PLE E N INJU RY PAGE 27

Liver Anatomy Overview

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
Liver Injury Scaling 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

All Liver Injury Statistics

25%

OR
Isolated Liver Injury Statistics

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 L I V E R INJU RY S PLE E N INJU RY PAG E 2 8

Liver Anatomy Overview

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
Liver Injury Scaling O R E A R LY D E AT H 2 4 H O U R S - LO S

Liver Injury Images

All Liver Injury Statistics

18

L O S ( DAYS )
Isolated Liver Injury Statistics
16
Isolated Liver Injury without
Severe Head Trauma Statistics 14

Isolated Liver Injury without

12
Severe Head Trauma or Early
Death 24 Hours Statistics
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

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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
Liver Anatomy Overview O R E A R LY D E AT H 24 HOURS - ICU

Liver Injury Scaling

10

I C U ( DAYS )
Liver Injury Images
9
All Liver Injury Statistics
8

Isolated Liver Injury Statistics 7

Isolated Liver Injury without 6

Severe Head Trauma Statistics
5
Isolated Liver Injury without
4
Severe Head Trauma or Early
Death 24 Hours Statistics 3

2
Liver Injuries-Mortality
1
Liver Injuries-OR
Liver Injuries-LOS 0
1 & 2 3 4 5 6 TOTA L
Liver Injuries-ICU OIS GRADE

LOS (DAYS) ICU (DAYS)

OIS GRADE N MORTALITY (%) OR (%)
MEAN SD (MEDIAN) MEAN SD (MEDIAN)
1&2 12811 1.9% 7.1% 8.0 10.8 (5.0) 5.7 9.0 (3.0)
3 4662 1.5% 12.0% 8.4 10.3 (5.0) 5.0 7.3 (2.0)
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 < 0.025. 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 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. 2014 American College of Surgeons
The user agrees to release and idemnify the American College of Surgeons from claims arising from use of the publication.
 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

GRADE* I N J U RY D E S C R I P TI O N ICD 9 AIS 90
Isolated Spleen Injury Statistics 865.01

Isolated Spleen Injury without

Severe Head Trauma Statistics
Subcapsular hematoma, <10% surface area; capsular tear, <1 cm
parenchymal depth
865.11
865.02
865.12
2

Isolated Spleen Injury without Subcapsular hematoma, 10%50% surface area; intraparenchymal, <5 cm in diameter; 865.01
Severe Head Trauma or Early
Death 24 Hours Statistics laceration 13 cm parenchymal depth, <10 cm in length which does not involve a
trabecular vessel
865.11
865.03
865.13
2

NTDB* Spleen Injury Mortality Rates

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

Laceration involving segmental or hilar vessels producing major devascularization

(>25% of spleen) 4

Completely shattered spleen; hilar vascular injury which devascularizes spleen 865.04
865.14
5

*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.

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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 I N J U RY D E S C R I P TI O N ICD -9 AIS 90

865.01
865.11
Subcapsular hematoma, <10% surface area; capsular tear, <1 cm parenchymal depth
865.02
865.12
2

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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 I N J U RY D E S C R I P TI O N ICD -9 AIS 90

865.01
865.11
Subcapsular hematoma, <10% surface area; capsular tear, <1 cm parenchymal depth
865.02
865.12
2

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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 I N J U RY D E S C R I P TI O N ICD -9 AIS 90

865.01
Subcapsular hematoma, 10550% surface area; intraparenchymal, <5 cm in diameter;
865.11
laceration 13 cm parenchymal depth, <10 cm in length which does not involve a
trabecular vessel
865.03
865.13
2

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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 I N J U RY D E S C R I P TI O N ICD -9 AIS 90

865.01
Subcapsular hematoma, 10%50% surface area; intraparenchymal, <5 cm in diameter;
865.11
laceration 13 cm parenchymal depth, <10 cm in length which does not involve a
trabecular vessel
865.03
865.13
2

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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 I N J U RY D E S C R I P TI O N ICD -9 AIS 90

Subcapsular hematoma, >50% surface area or expanding; ruptured subcapsular or

865.03
parenchymal hematoma; intraparenchymal hematoma >5 cm or expanding;
laceration >3 cm parenchymal depth or involving trabecular vessels
865.13
3

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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 I N J U RY D E S C R I P TI O N ICD -9 AIS 90

Subcapsular hematoma, >50% surface area or expanding; ruptured subcapsular or

865.03
parenchymal hematoma; intraparenchymal hematoma >5 cm or expanding; laceration
>3 cm parenchymal depth or involv ing trabecular vessels
865.13
3

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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

( W IT H E X T R AVA SATI O N)

GRADE I N J U RY D E S C R I P TI O N ICD -9 AIS 90

Laceration involving segmental or hilar vessels producing major

devascularization (>25% of spleen)
4

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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

( W IT H O U T E X T R AVA SATI O N)

GRADE I N J U RY D E S C R I P TI O N ICD -9 AIS 90

Laceration involving segmental or hilar vessels producing major

devascularization (>25% of spleen)
4

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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 I N J U RY D E S C R I P TI O N ICD -9 AIS 90

Laceration involving segmental or hilar vessels producing major devascularization

(>25% of spleen)
4

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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 I N J U RY D E S C R I P TI O N ICD -9 AIS 90

865.04
Completely shattered spleen; hilar vascular injury which devascularizes spleen
865.14
5

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 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

All Spleen Injury Statistics

Isolated Spleen Injury Statistics 20%

M O R TA L I T Y
Isolated Spleen Injury without
Severe Head Trauma Statistics

Isolated Spleen Injury without 15%

Severe Head Trauma or Early
Death 24 Hours Statistics

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

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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
Spleen Injury Images
70%

OR
All Spleen Injury Statistics

Isolated Spleen Injury Statistics 60%

Isolated Spleen Injury without

Severe Head Trauma Statistics 50%

Isolated Spleen Injury without

Severe Head Trauma or Early
40%
Death 24 Hours Statistics

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

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Spleen Anatomy

Spleen Injury Scaling

S P L E E N I N J U R I E S LO S
Spleen Injury Images

All Spleen Injury Statistics

Isolated Spleen Injury Statistics 14

L O S ( DAYS )
Isolated Spleen Injury without
Severe Head Trauma Statistics 12

Isolated Spleen Injury without

Severe Head Trauma or Early 10
Death 24 Hours Statistics

Spleen Injuries-Mortality 6

Spleen Injuries-OR
Spleen Injuries-LOS 4

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 PAG E 4 5

Spleen Anatomy SPLEEN INJURIES ICU

Spleen Injury Scaling

Spleen Injury Images 9

I C U ( DAYS )
All Spleen Injury Statistics 8

Isolated Spleen Injury Statistics

7

Isolated Spleen Injury without

Severe Head Trauma Statistics 6

Isolated Spleen Injury without 5

Severe Head Trauma or Early
Death 24 Hours Statistics 4

2
Spleen Injuries-Mortality
Spleen Injuries-OR 1

Spleen Injuries-LOS 0

Spleen Injuries-ICU 1 & 2 3 4 5 TOTA L

OIS GRADE

LOS (DAYS) ICU (DAYS)

OIS GRADE N MORTALITY (%) OR (%)
MEAN SD (MEDIAN) MEAN SD (MEDIAN)
1&2 18617 7.4% 11.3% 10.3 13.5 (5.0) 6.9 9.6 (3.0)
3 2902 5.6% 16.7% 10.5 13.9 (5.0) 6.3 9.4 (2.0)
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.
NTDB VERSION 8-11

National Trauma Data Bank (NTDB) 2014 American College of Surgeons

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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

Isolated Spleen Injury Statistics

15%

M O R TA L I T Y
Isolated Spleen Injury without
Severe Head Trauma Statistics

Isolated Spleen Injury without

Severe Head Trauma or Early
Death 24 Hours Statistics 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

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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

Isolated Spleen Injury Statistics 60%

OR
Isolated Spleen Injury without
Severe Head Trauma Statistics 50%

Isolated Spleen Injury without

Severe Head Trauma or Early
40%
Death 24 Hours Statistics

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

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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

Isolated Spleen Injury Statistics 12

L O S ( DAYS )
Isolated Spleen Injury without
Severe Head Trauma Statistics
10
Isolated Spleen Injury without
Severe Head Trauma or Early
Death 24 Hours Statistics 8

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
Spleen Injury Images
7

I C U ( DAYS )
All Spleen Injury Statistics

Isolated Spleen Injury Statistics 6

Isolated Spleen Injury without

Severe Head Trauma Statistics 5

Isolated Spleen Injury without

4
Severe Head Trauma or Early
Death 24 Hours Statistics
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) ICU (DAYS)

OIS GRADE N MORTALITY (%) OR (%)
MEAN SD (MEDIAN) MEAN SD (MEDIAN)
1&2 12937 5.40% 9.20% 9.1 6.2
3 2033 3.50% 13.70% 8.8 5.4
4 5946 5.70% 25.00% 9.1 5.6
5 2759 10.90% 56.00% 10.3 6.5
TOTAL 23675 6.00% 19.10% 9.2 6

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.
NTDB VERSION 8-11

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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 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 Images

All Spleen Injury Statistics

Isolated Spleen Injury Statistics

10%

M O R TA L I T Y
Isolated Spleen Injury without
Severe Head Trauma Statistics
8%
Isolated Spleen Injury without
Severe Head Trauma or Early
Death 24 Hours Statistics 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

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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 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 Images

All Spleen Injury Statistics

Isolated Spleen Injury Statistics

OR
60%

Isolated Spleen Injury without

Severe Head Trauma Statistics 50%

Isolated Spleen Injury without

Severe Head Trauma or Early 40%
Death 24 Hours Statistics
30%

Spleen Injuries-Mortality 20%

Spleen Injuries-OR
Spleen Injuries-LOS 10%

Spleen Injuries-ICU
0%
1 & 2 3 4 5 TOTA L

OIS GRADE

NTDB VERSION 8-11

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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 W/O

S E V E R E H E A D T R AU M A - LO S
Spleen Injury Images

All Spleen Injury Statistics

Isolated Spleen Injury Statistics

12

L O S ( DAY )
Isolated Spleen Injury without
Severe Head Trauma Statistics 10

Isolated Spleen Injury without

Severe Head Trauma or Early 8
Death 24 Hours Statistics
6

Spleen Injuries-Mortality 4

Spleen Injuries-OR
Spleen Injuries-LOS 2

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

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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 W/O

S E V E R E H E A D T R AU M A - I C U
Spleen Injury Images

All Spleen Injury Statistics 7

ICU
Isolated Spleen Injury Statistics
6

Isolated Spleen Injury without

Severe Head Trauma Statistics 5

Isolated Spleen Injury without 4

Severe Head Trauma or Early
Death 24 Hours Statistics
3

Spleen Injuries-Mortality
1
Spleen Injuries-OR
Spleen Injuries-LOS 0
1 & 2 3 4 5 TOTA L
Spleen Injuries-ICU
OIS GRADE

LOS (DAYS) ICU (DAYS)

OIS GRADE N MORTALITY (%) OR (%)
MEAN SD (MEDIAN) 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

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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 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
Spleen Injury Images

All Spleen Injury Statistics

Isolated Spleen Injury Statistics

4%

M O R TA L I T Y
Isolated Spleen Injury without 3.5%
Severe Head Trauma Statistics
3%
Isolated Spleen Injury without
Severe Head Trauma or Early
2.5%
Death 24 Hours Statistics

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

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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 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
Spleen Injury Images

All Spleen Injury Statistics

Isolated Spleen Injury Statistics

60%

OR
Isolated Spleen Injury without
Severe Head Trauma Statistics 50%

Isolated Spleen Injury without

Severe Head Trauma or Early 40%
Death 24 Hours Statistics
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 PAGE 5 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 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
Spleen Injury Images

All Spleen Injury Statistics

Isolated Spleen Injury Statistics

12

L O S ( DAYS )
Isolated Spleen Injury without
Severe Head Trauma Statistics 10

Isolated Spleen Injury without

Severe Head Trauma or Early 8
Death 24 Hours Statistics
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 57

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 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 Images

All Spleen Injury Statistics

7

I C U ( DAYS )
Isolated Spleen Injury Statistics
6
Isolated Spleen Injury without
Severe Head Trauma Statistics 5

Isolated Spleen Injury without

4
Severe Head Trauma or Early
Death 24 Hours Statistics
3

Spleen Injuries-Mortality 1
Spleen Injuries-OR
0
Spleen Injuries-LOS 1 & 2 3 4 5 TOTA L

Spleen Injuries-ICU OIS GRADE

LOS (DAYS) ICU (DAYS)

OIS GRADE N MORTALITY (%) OR (%)
MEAN SD (MEDIAN) MEAN SD (MEDIAN)
1&2 11229 1.7% 8.9% 8.2 10.6 (7.0) 5.5 8.6 (2.0)
3 1821 1.0% 13.3% 7.7 8.4 (6.0) 4.4 7.0 (2.0)
4 5304 1.7% 23.6% 8.5 10.4 (6.0) 5.1 8.3 (3.0)
5 2349 3.7% 54.3% 10.1 11.9 (7.0) 6.1 10.0 (3.0)
TOTAL 20703 1.9% 18.3% 8.5 10.4 (7.0) 5.4 8.6 (3.0)

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 < 0.025.
NTDB VERSION 8-11

National Trauma Data Bank (NTDB) 2014 American College of Surgeons