American Association for the Surgery of Trauma pancreatic organ injury scale: 2024 Revision

David M. Notrica, From the Division of Pediatric Surgery (D.M.N.), Phoenix Children's Hospital Level I Pediatric Trauma Center, Phoenix, Arizona; Deparment of Child Health and Sugery, University of Arizona College of Medicine Phoenix (D.M.N.), Department of Surgery, Mayo Clinic College of Medicine and Science (D.M.N.); Scripps Medical Group (G.T.T.); Trauma Services (G.T.T.), Scripps Memorial Hospital La Jolla, La Jolla, California; Department of Radiology (J.A.G.), Harborview Medical Center, University of Washington, Seattle, Washington; Department of Radiology, Emergency and Trauma Imaging (R.N.S.), Phoenix Children's Hospital; Departments of Radiology (R.N.S.) and Child Health (R.N.S.), University of Arizona College of Medicine, Phoenix, Arizona; Department of Radiology (R.N.S.), Creighton University College of Medicine, Phoenix, Arizona; Mayo Clinic (R.N.S.), Johns Hopkins Hospital; Mayo Clinic College of Medicine (M.E.M.), University of Arizona, Phoenix; Department of Gastroenterology (M.E.M.), Phoenix Children's Hospital, Phoenix, Arizona; (M.E.M.); Department of Surgery (M.C.), Case Western Reserve University, MetroHealth, Cleveland, Ohio; Shock Trauma Center (R.K.), University of Maryland School of Medicine, Baltimore, Maryland; Community Regional Medical Center (K.L.K.); Department of Surgery (K.M.S.), Yale School of Medicine; and Department of Surgery (C.G.B.), University of Calgary.
Gail T. Tominaga
Joel A. Gross
Richard N. Southard
Mark E. McOmber
Marie Crandall
Rosemary Kozar
Krista L. Kaups
Kevin M. Schuster
Chad G. Ball

Document Type

Article

Publication Title

The journal of trauma and acute care surgery

Abstract

BACKGROUND: The American Association for the Surgery of Trauma Organ Injury Scale (OIS) Committee published the original pancreatic OIS in 1990 with the authors acknowledging at the time that the classification would need to undergo "continued refinement as clinical experience dictates." The current OIS overemphasizes injury location over ductal integrity; modifications are needed to improve concordance between OIS, therapy, and outcomes and promote accuracy in quality assessment and research. METHODS: A subcommittee of the American Association for the Surgery of Trauma and invited experts in radiology and interventional gastroenterology were chosen. Contemporary literature was reviewed, and a standardized iterative and collegial process was used to arrive at consensus. RESULTS: The pancreatic OIS is anatomically based on operative, radiographic, or pathologic findings. Major changes to the grading system include moving lacerations of the pancreatic head without ductal injury from Grade IV to Grade II. Injuries to the duct in the neck, body, or tail remain Grade III but are further subclassified to distinguish between deep parenchymal injuries without ductal interrogation, partial ductal injuries, and complete ductal transection. Grade IV injuries follow the same nomenclature but for injuries to the right of the portal vein or superior mesenteric vein. Grade V injuries are destructive injuries of the pancreatic head with nonviable parenchyma. These injuries are further subgraded based on ductal injuries. CONCLUSION: The pancreatic OIS schema is revised based on contemporary experience informed by the current understanding of outcomes and treatment, including operative management and outcomes. Increasing grades now more closely reflect increasing severity. LEVEL OF EVIDENCE: Expert Opinion; Level V.

DOI

10.1097/TA.0000000000004522

Publication Date

2-3-2025

Identifier

39898876 (pubmed); 10.1097/TA.0000000000004522 (doi); 01586154-990000000-00903 (pii)

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