The spleen is the most commonly injured organ in the abdomen as a result of blunt abdominal trauma, with an incidence of 25%. Historically, the treatment of choice for splenic injury was surgical, commonly splenectomy. However, splenectomy is associated with a life-long risk for potentially fatal sepsis due to encapsulated bacteria. This has led to an evolution in the management of splenic injuries to appropriately triage patients toward operative versus nonoperative management. Currently, nonoperative management of isolated blunt splenic injury is considered the standard of care for hemodynamically stable children. Patients who are hemodynamically unstable should proceed directly to surgical exploration.

Patients who are hemodynamically stable routinely receive a CT examination (see figures). The degree of splenic injury is assessed and assigned a grade. The grade will help in determining whether the patient will or will not require intervention and the need for continued evaluation of the spleen. The grading method depends on size, depth, and number of the lacerations and hematomas; amount of extravasation; and whether there is continued bleeding (see figures).

Splenic trauma is commonly graded using the Organ Injury Scaling system (American Association for the Surgery of Trauma). A grade I injury is the least-severe injury and is a subcapsular hematoma less than 10% of splenic surface area and/or a small capsular tear no deeper than 1 cm, nonexpanding, not actively bleeding. A grade V injury is a shattered spleen with involvement of the splenic vascular pedicle.