AAST grade | Severity imaging criteria (CT findings) | Operative goals | Pathologic criteria |
I | - Subcapsular hematoma and/or parenchymal contusion without laceration
| - Nonexpanding subcapsular hematoma
- Parenchymal contusion without laceration
| - Subcapsular hematoma or parenchymal contusion without parenchymal laceration
|
II | - Perirenal hematoma confined to Gerota fascia
- Renal parenchymal laceration ≤1 cm depth without urinary extravasation
| - Nonexpanding perirenal hematoma confined to Gerota fascia
- Renal parenchymal laceration ≤1 cm depth without urinary extravasation
| - Perirenal hematoma confined to Gerota fascia
- Renal parenchymal laceration ≤1 cm depth without urinary extravasation
|
III | - 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
| - 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
|
IV | - Parenchymal laceration extending into urinary collecting system with urinary extravasation
- Renal pelvis laceration and/or complete ureteropelvic disruption
- 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
| - Parenchymal laceration extending into urinary collecting system with urinary extravasation
- Renal pelvis laceration and/or complete ureteropelvic disruption
- Segmental renal vein or artery injury
- Segmental or complete kidney infarction(s) due to vessel thrombosis without active bleeding
| - Parenchymal laceration extending into urinary collecting system
- Renal pelvis laceration and/or complete ureteropelvic disruption
- Segmental renal vein or artery injury
- Segmental or complete kidney infarction(s) due to vessel thrombosis without active bleeding
|
V | - Main renal artery or vein laceration or avulsion of hilum
- Devascularized kidney with active bleeding
- Shattered kidney with loss of identifiable parenchymal renal anatomy
| - Main renal artery or vein laceration or avulsion of hilum
- Devascularized kidney with active bleeding
- Shattered kidney with loss of identifiable parenchymal renal anatomy
| - Main renal artery or vein laceration or avulsion of hilum
- Devascularized kidney
- Shattered kidney with loss of identifiable parenchymal renal anatomy
|