🫀 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.
Hepatic Injury Grading (AAST 2018)
Most severe feature (take the worst of hematoma/laceration/vascular injury)
When to use
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.
How it works
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.
Key points
- 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.
References
- Kozar RA, et al. Organ injury scaling 2018 update: Spleen, liver, and kidney. J Trauma Acute Care Surg 2018.
- Coccolini F, et al. WSES classification and guidelines for liver trauma. World J Emerg Surg 2016.
Decision support for licensed clinicians only; not a substitute for clinical judgement, diagnosis or local protocols.