Descreva o achado como no laudo. A resposta aponta uma das categorias publicadas, com a probabilidade e o trecho que a decide.
Categorias
Reescritas a partir da fonte e citadas
I
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Grade I
Minor injury: subcapsular hematoma covering less than 10% of the splenic surface area, and/or a parenchymal laceration under 1 cm deep, and/or a simple capsular tear.
CondutaLow-grade injury (WSES minor, grades I-II): nonoperative management is the standard of care in hemodynamically stable patients - observation with serial vitals/hemoglobin. Splenic angioembolization is reserved for a contrast blush/vascular injury; surgery only for hemodynamic instability or failed NOM.
RiscoLowest-risk tier: nonoperative management succeeds in roughly 95-99% of low-grade injuries; overall NOM success across blunt splenic trauma is up to about 80%.
verificadoOrgan injury scaling 2018 update: spleen, liver, and kidney (AAST)Management grouping (low-grade I-II = NOM, embolization for blush) per WSES spleen classification PMC6580626 and StatPearls 'Splenic Injury' NBK441993; NOM success up to 80% overall per NBK441993.
II
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Grade II
Subcapsular hematoma involving 10-50% of surface area, or an intraparenchymal hematoma smaller than 5 cm; and/or a parenchymal laceration 1-3 cm deep.
CondutaLow-grade injury (WSES minor, grades I-II): nonoperative management in stable patients with serial monitoring; splenic artery angioembolization when CT shows a contrast blush, pseudoaneurysm, or AV fistula. Operative management (splenectomy/splenorrhaphy) reserved for instability or NOM failure.
RiscoLow-risk tier with high NOM success; a contrast blush raises failure risk - low-grade injuries with active extravasation may fail NOM in up to ~20% if not embolized.
Subcapsular hematoma exceeding 50% of surface area, or a ruptured subcapsular/intraparenchymal hematoma 5 cm or larger; and/or a parenchymal laceration deeper than 3 cm.
CondutaHigh-grade injury (WSES moderate, grade III): nonoperative management still attempted in stable patients, but splenic angioembolization is used liberally - grade III carries the highest embolization rate. Operative management for instability, peritonitis, or NOM failure.
RiscoHigher-risk tier: NOM failure and the need for intervention rise with grade; grade III had the highest angioembolization rate (~39%) in the WSES validation cohort.
Any injury accompanied by a splenic vascular injury (pseudoaneurysm or arteriovenous fistula) or active bleeding that remains confined within the splenic capsule; or a parenchymal laceration involving segmental or hilar vessels that produces more than 25% devascularization of the spleen.
CondutaHigh-grade injury (WSES severe, grades IV-V): operative management predominates - in stable patients NOM with angioembolization may be tried at high-acuity centers, but most undergo surgery (splenectomy). Unstable patients go directly to laparotomy.
RiscoHigh-risk tier: AAST grade greater than III had ~77% operative-management rate in the WSES cohort; grade and hemodynamic instability drive higher NOM failure and mortality.
Any injury with a splenic vascular injury where active bleeding extends beyond the spleen into the peritoneum; or a shattered spleen.
CondutaHigh-grade injury (WSES severe, grades IV-V): operative management (usually total splenectomy) is the rule, particularly with hemodynamic instability or a shattered spleen; damage-control surgery for the unstable patient. Highly selected stable grade V may attempt NOM with embolization at major trauma centers.
RiscoHighest-risk tier: grade V is an independent predictor of NOM failure and mortality; the great majority require operative management.