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Liver Injury Scale

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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Specialty

ICD-10