🫀 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.
Clinical takeaway
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)
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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.
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)
Frequently asked 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)）