Liver Injury Scale | Medicalalgorithms.com

Description

The severity of liver trauma can be graded based on the nature of the injuries. The following scales were developed by the American Association for the Surgery of Trauma. An alternative name is the Hepatic Injury Scale.

Original Scale from 1989

Type	Subtype	Description of Injury	Grade
hematoma	subcapsular	< 10% of surface area, nonexpanding	I
		10-50% of surface area, nonexpanding	II
		> 50% of surface area, nonexpanding	III
		expanding	III
		ruptured with active bleeding	III
	intra-parenchymal	< 2 cm in diameter, nonexpanding	II
		>= 2 cm in diameter, nonexpanding	III
		expanding	III
		ruptured with active bleeding	IV
laceration	parenchyma	< 1 cm depth (capsular tear), nonbleeding	I
		< 1 cm depth (capsular tear), active bleeding	II
		depth 1-3 cm, < 10 cm in length	II
		depth > 3 cm	III
	disruption	<= 50% of hepatic lobe	IV
		> 50% of hepatic lobe	V
vascular		juxtahepatic venous injury (retrohepatic vena cava, major hepatic veins)	V
		hepatic avulsion	VI

If multiple injuries are present to the liver, then advance the grade by one.

Injuries of Grades III-VI are considered severe.

Revised Scale from 1994

Type	Subtype	Description of Injury	Grade
hematoma	subcapsular	< 10% of surface area, nonexpanding	I
		10-50% of surface area, nonexpanding	II
		> 50% of surface area, nonexpanding	III
		expanding	III
		ruptured	III
	intra-parenchymal	< 10 cm in diameter, nonexpanding	II
		>= 10 cm in diameter, nonexpanding	III
		expanding	III
		ruptured	III
laceration	parenchyma	capsular tear, < 1 cm parenchymal depth	I
		depth 1-3 cm, < 10 cm in length	II
		depth > 3 cm	III
	disruption	25-75% of hepatic lobe, or 1-3 Couinaud's segments within a single lobe	IV
		> 75% of hepatic lobe, or > 3 Couinaud's segments within a single lobe	V
vascular		juxtahepatic venous injury (retrohepatic vena cava, major hepatic veins)	V
		hepatic avulsion	VI

If multiple injuries are present to the liver, then advance the grade by one, up to grade III.

where:

• I am assuming that a Grade II lesion can be upgraded to Grade III, but not Grade III to Grade IV (see Testis Injury Scale).

Other changes from original version:

(1) hematomas downgraded due to relatively benign course, with threshold changed to 10 cm

(2) addition of Couinaud's segmental liver anatomy

(3) more rigorous criteria for grade IV and grade V injuries

(4) change to 75% parenchymal disruption to separate grades IV and V

NOTE: I am not sure how a laceration 1-3 cm deep and >= 10 cm is graded. This may get into the > 25% hepatic lobe involvement.

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Description

Specialty

ICD-10