🫀 Hepatic Injury Grading (AAST 2018)
UseUse in blunt or penetrating abdominal trauma to assign a hepatic injury grade and frame the choice between no…
SourceCoccolini F, et al. WSES classification and guidelines for liver trauma. World J Emerg Surg 2016.
This-shift next steps
After scoring: open the scene pack, peer scores, and the matching pathway. Local reference — no HIS write.
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Methodology · worked example, guidelines & full notes
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)
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
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) | III: subcapsular > 50%/ruptured or intraparenchymal hematoma > 10 cm or laceration > 3 cm or intraparenchymal vascular injury/active bleeding (2018) |
|---|
→AAST hepatic injuryGrade III
- Grade：Grade III (I–V, higher is more severe)
- Management direction：Hemodynamically stable may have NOM; with vascular injury/active bleeding consider angioembolization (IR)
- 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) | 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)
Verification & sources · governance
FAQ
Frequently asked questions
- 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.
- Does Hepatic Injury Grading (AAST 2018) upload patient data? Where is it calculated?
- Calculation runs locally in the browser; inputs and results are not uploaded. For licensed clinicians only; interpret with history, investigations and local protocols — not a diagnosis or prescription.
- 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) III: subcapsular > 50%/ruptured or intraparenchymal hematoma > 10 cm or laceration > 3 cm or intraparenchymal vascular injury/active bleeding (2018) → Result: AAST hepatic injury Grade III（Grade: Grade III (I–V, higher is more severe), Management direction: Hemodynamically stable may have NOM; with vascular injury/active bleeding consider angioembolization (IR), 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) 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)）