Hepatic Injury Grading (AAST 2018) — free guideline decision tool
This tool grades hepatic injury I–V using the AAST 2018 Organ Injury Scale, graded by the most severe imaging/operative feature, to guide management within a hemodynamics-first framework.
Open guideline tool →Guideline-based
Implements the decision logic from published clinical guidelines.
Runs in your browser
No installation. Enter the patient's values and get a guideline recommendation instantly.
Data stays local
Nothing is uploaded. Results are for licensed clinicians only.
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| Most severe feature (take the worst of hematoma/laceration/vascular injury) | I: subcapsular hematoma < 10% or laceration < 1 cm deep |
|---|
→AAST hepatic injuryGrade I
- Grade：Grade I (I–V, higher is more severe)
- Management direction：Usually nonoperative management (NOM): observation, monitoring hemoglobin and vital signs
- Key principle：Hemodynamic status takes priority over anatomic grade (WSES): any grade with hemodynamic instability → surgery; a stable high grade may still have NOM. Multiple intrahepatic injuries may upgrade by one grade (to III)
| Most severe feature (take the worst of hematoma/laceration/vascular injury) | V: > 75% of a lobe or retrohepatic vena cava/central hepatic vein injury |
|---|
→AAST hepatic injuryGrade V
- Grade：Grade V (I–V, higher is more severe)
- Management direction：Highly complex, often requires surgery (damage control/perihepatic packing); retrohepatic caval injury has high mortality
- Key principle：Hemodynamic status takes priority over anatomic grade (WSES): any grade with hemodynamic instability → surgery; a stable high grade may still have NOM. Multiple intrahepatic injuries may upgrade by one grade (to III)
Common questions
What is Hepatic Injury Grading (AAST 2018)?
This tool grades hepatic injury I–V using the AAST 2018 Organ Injury Scale, graded by the most severe imaging/operative feature, to guide management within a hemodynamics-first framework.
How is Hepatic Injury Grading (AAST 2018) calculated? What is the core formula?
Grade by the worst of hematoma/laceration/vascular injury. I–II usually NOM; III stable → NOM ± embolization; IV stable → NOM + embolization at capable centers, unstable → surgery; V usually surgery.
When is Hepatic Injury Grading (AAST 2018) used?
Use in blunt or penetrating abdominal trauma to assign a hepatic injury grade and frame the choice between nonoperative management, angioembolization, and damage-control surgery.
What are the key clinical points for Hepatic Injury Grading (AAST 2018)?
Hemodynamic status takes priority over the anatomic grade: any grade with instability goes to surgery, while a stable high grade may still be managed nonoperatively. (original synthesis · not guideline verbatim) The 2018 revision incorporates vascular injury and intraparenchymal active bleeding and drops Couinaud-segment counting for low grades. Retrohepatic vena cava/central hepatic vein injury (grade V) carries high mortality and often needs perihepatic packing.
What are the limits and cautions when using Hepatic Injury Grading (AAST 2018)?
For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
How is Hepatic Injury Grading (AAST 2018) calculated in practice? Can you show a worked example?
Inputs: Most severe feature (take the worst of hematoma/laceration/vascular injury) I: subcapsular hematoma < 10% or laceration < 1 cm deep → Result: AAST hepatic injury Grade I（Grade: Grade I (I–V, higher is more severe), Management direction: Usually nonoperative management (NOM): observation, monitoring hemoglobin and vital signs, Key principle: Hemodynamic status takes priority over anatomic grade (WSES): any grade with hemodynamic instability → surgery; a stable high grade may still have NOM. Multiple intrahepatic injuries may upgrade by one grade (to III)） Inputs: Most severe feature (take the worst of hematoma/laceration/vascular injury) V: > 75% of a lobe or retrohepatic vena cava/central hepatic vein injury → Result: AAST hepatic injury Grade V（Grade: Grade V (I–V, higher is more severe), Management direction: Highly complex, often requires surgery (damage control/perihepatic packing); retrohepatic caval injury has high mortality, Key principle: Hemodynamic status takes priority over anatomic grade (WSES): any grade with hemodynamic instability → surgery; a stable high grade may still have NOM. Multiple intrahepatic injuries may upgrade by one grade (to III)）
Run Hepatic Injury Grading (AAST 2018) now
This tool grades hepatic injury I–V using the AAST 2018 Organ Injury Scale, graded by the most severe imaging/operative feature, to guide management within a hemodynamics-first framework.
Open guideline tool →For licensed clinicians. Not a substitute for clinical judgement.
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