AAST liver injury scale
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At the time the article was created Frank Gaillard had no recorded disclosures.
View Frank Gaillard's current disclosuresAt the time the article was last revised Joachim Feger had no financial relationships to ineligible companies to disclose.
View Joachim Feger's current disclosures- Hepatic injury grading
- Liver injury grading
- Liver trauma grading
- Grading of liver trauma
- Liver trauma grade
The AAST (American Association for the Surgery of Trauma) liver injury scale, recently revised in 2018, is the most widely used liver injury grading system 3.
The 2018 update incorporates "vascular injury" (i.e. pseudoaneurysm, arteriovenous fistula) into the imaging criteria for visceral injury 3.
Classification
-
grade I
hematoma: subcapsular, <10% surface area
laceration: capsular tear, <1 cm parenchymal depth
-
grade II
hematoma: subcapsular, 10-50% surface area
hematoma: intraparenchymal <10 cm diameter
laceration: capsular tear 1-3 cm parenchymal depth, <10 cm length
-
grade III
hematoma: subcapsular, >50% surface area; ruptured subcapsular or parenchymal hematoma
hematoma: intraparenchymal >10 cm
laceration: capsular tear >3 cm parenchymal depth
vascular injury with active bleeding contained within liver parenchyma
-
grade IV
laceration: parenchymal disruption involving 25-75% of a hepatic lobe or involves 1-3 Couinaud segments
vascular injury with active bleeding breaching the liver parenchyma into the peritoneum
-
grade V
laceration: parenchymal disruption involving >75% of hepatic lobe
vascular: juxtahepatic venous injuries (retrohepatic vena cava / central major hepatic veins)
Additional points
advance one grade for multiple injuries up to grade III
for each grade, the worst feature is chosen, either hematoma or laceration (no need for both/all to coexist)
"vascular injury" (i.e. pseudoaneurysm or AV fistula): appears as a focal collection of vascular contrast which decreases in attenuation on delayed images
"active bleeding": focal or diffuse collection of vascular contrast which increases in size or attenuation on a delayed phase
Imaging technique
The AAST guidelines recommend dual arterial/portal venous phase imaging to evaluate a vascular injury of the liver, spleen, or kidney 3.
Quiz questions
References
- 1.The American Association for the Surgery of Trauma - Injury Scoring Scale [website]
- 2. Tinkoff G, Esposito T, Reed J et al. American Association for the Surgery of Trauma Organ Injury Scale I: Spleen, Liver, and Kidney, Validation Based on the National Trauma Data Bank. J Am Coll Surg. 2008;207(5):646-655. doi:10.1016/j.jamcollsurg.2008.06.342
- 3. Kozar R, Crandall M, Shanmuganathan K et al. Organ Injury Scaling 2018 Update: Spleen, Liver, and Kidney. J Trauma Acute Care Surg. 2018;85(6):1119-1122. doi:10.1097/ta.0000000000002058
- 4. Croce M, Fabian T, Kudsk K et al. AAST Organ Injury Scale: Correlation of CT-Graded Liver Injuries and Operative Findings. J Trauma. 1991;31(6):806-12. - Pubmed
Incoming Links
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