AAST chest wall injury scale*

Grade	Injury type	Description of injury
I	Contusion	Any size
	Laceration	Skin and subcutaneous
	Fracture	<3 ribs, closed; nondisplaced clavicle closed (AIS 1 to 2)
II	Laceration	Skin, subcutaneous and muscle
	Fracture	≥3 adjacent ribs, closed (AIS 2 to 3)
		Open or displaced clavicle
		Nondisplaced sternum, closed
		Scapular body, open or closed
III	Laceration	Full thickness including pleural penetration
	Fracture	Open or displaced sternum
		Flail sternum
		Unilateral flail segment (<3 ribs; AIS 3 to 4)
IV	Laceration	Avulsion of chest wall tissues with underlying rib fractures
IV	Fracture	Unilateral flail chest (≥3 ribs; AIS 3 to 4)
V	Fracture	Bilateral flail chest (≥3 ribs on both sides; AIS 5)

AAST: American Association for the Surgery of Trauma; AIS: Abbreviated Injury Scale.

* This scale is confined to the chest wall alone and does not reflect associated internal or abdominal injuries. Therefore, further delineation of upper versus lower or anterior versus posterior chest wall was not considered, and a grade VI was warranted. Specifically, thoracic crush was not used as a descriptive term; instead, the geography and extent of fractures and soft tissue injury were used to define the grade.

Reproduced with permission from: Moore EE, Cogbill TH, Jurkovich GJ, et al. Organ injury scaling. III: Chest wall, abdominal vascular, ureter, bladder, and urethra. J Trauma 1992; 33:337. Copyright © 1992 Lippincott Williams & Wilkins.

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AAST chest wall injury scale*