The American Association for the Surgery of Trauma Uniform Grading of Hemorrhagic Emergency General Surgery Diseases

ABSTRACTConsistent grading of Emergency General Surgery (EGS) diseases is important for comparison of outcomes and development of EGS registries. The American Association for the Surgery of Trauma (AAST) Patient Assessment Committee has previously determined common EGS diseases and developed a grading system for measuring anatomic severity of 16 inflammatory/infectious EGS diseases. The specific aim of this project was to develop a uniform grading template for hemorrhagic EGS diseases managed by acute care surgeons and apply the template to common hemorrhagic EGS diseases.The AAST Patient Assessment Committee reviewed the literature and examined the existing grading systems available for common hemorrhagic EGS diseases. A uniform grading template was created with Grade I – occult hemorrhage, Grade II –minimal hemorrhage with no active bleeding, Grade III – limited hemorrhage with no active bleeding, Grade IV – moderate hemorrhage with active bleeding, and Grade V – large volume hemorrhage. The template was applied to four common hemorrhagic EGS diseases: bleeding esophageal varices (EV), hemorrhage from colonic diverticulosis (CD), bleeding peptic ulcer disease (PUD), and ruptured abdominal aortic aneurysm (AAA). We believe that physiologic parameters, volume loss, and rate of bleeding are essential co-determinants of outcomes in hemorrhagic conditions. However, adding to this an understanding of anatomic progression of disease may help inform treatment decisions and predict outcomes.Level of EvidenceIIIStudy TypeCurrent opinions Consistent grading of Emergency General Surgery (EGS) diseases is important for comparison of outcomes and development of EGS registries. The American Association for the Surgery of Trauma (AAST) Patient Assessment Committee has previously determined common EGS diseases and developed a grading system for measuring anatomic severity of 16 inflammatory/infectious EGS diseases. The specific aim of this project was to develop a uniform grading template for hemorrhagic EGS diseases managed by acute care surgeons and apply the template to common hemorrhagic EGS diseases. The AAST Patient Assessment Committee reviewed the literature and examined the existing grading systems available for common hemorrhagic EGS diseases. A uniform grading template was created with Grade I – occult hemorrhage, Grade II –minimal hemorrhage with no active bleeding, Grade III – limited hemorrhage with no active bleeding, Grade IV – moderate hemorrhage with active bleeding, and Grade V – large volume hemorrhage. The template was applied to four common hemorrhagic EGS diseases: bleeding esophageal varices (EV), hemorrhage from colonic diverticulosis (CD), bleeding peptic ulcer disease (PUD), and ruptured abdominal aortic aneurysm (AAA). We believe that physiologic parameters, volume loss, and rate of bleeding are essential co-determinants of outcomes in hemorrhagic conditions. However, adding to this an understanding of anatomic progression of disease may help inform treatment decisions and predict outcomes. Level of Evidence III Study Type Current opinions Source of Funding: None Corresponding Author: Gail T. Tominaga, M.D., Trauma Section, Scripps Memorial Hospital La Jolla, 9888 Genesee Ave, LJ 601, La Jolla, California 92037, Phone: 858-626-6362 (Trauma Office), 858-824-5001 (Answering Service); 858-531-6161 (cell), FAX: 858-626-6354. Email: Tominaga.gail@scrippshealth.org Conflicts of Interest: None Meeting presentation:12th Annual Academic Surgical Congress, 02/09/2017 in Las Vegas, Nevada Disclosure of Funding: None © 2017 Lippincott Williams & Wilkins, Inc.

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