The capability of computed tomographic (CT) grading systems to enable prediction of successful nonsurgical treatment of splenic trauma in children and adults was evaluated. Fifty-six patients with documented splenic injury were examined with CT by use of standard trauma protocols. Each CT scan was graded according to two recently proposed grading systems. The charts of these patients were then reviewed, and correlations between the CT grade and clinical outcome were determined with each grading system. Forty patients underwent successful nonsurgical treatment; three of these patients (8%) underwent delayed celiotomy for splenic rupture after failure of nonsurgical treatment. Two of these three had grades that indicated nonsurgical treatment was viable. In each of these three patients, splenectomy was necessary. In the 16 patients who underwent surgery, eight cases (50%) of CT grading errors were documented with surgery. In four cases, the extent of the injury was underscored with CT, and in another four cases the injury was overscored. It is still not clear whether the severity of splenic injury as defined with CT correlates with clinical outcome.