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The purpose of a scaling system for specific injuries is to provide a common language to facilitate clinical decisions as well as the investigative basis for this decision-making. This brief overview describes the evolution and current status of the Organ Injury Scaling system developed by the American Association for the Surgery of Trauma. The Organ Injury Scaling system is based on the magnitude of anatomic disruption and is graded: 1 (minimal), 2 (mild), 3 (moderate), 4 (severe), 5 (massive), and 6 (lethal). To date, the Organ Injury Scaling system has been developed for visceral and vascular injuries of the neck, chest, abdomen, and extremities.