Updated Liver Organ Injury Scale

Description

Kozar et al reported an updated injury scale for hepatic trauma

Detection may be based on CT, operative or pathologic findings

Parameters:

(1) subcapsular hematoma

(2) parenchymal laceration

(3) intraparenchymal hematoma

(4) vascular injury and/or bleeding

(5) parenchymal disruption

(6) other

Parameter	Finding	AAST Grade
subcapsular hematoma	none	0
	< 10% of surface area	I
	10 to 50% of surface area	II
	> 50% of surface area OR ruptured	III
parenchymal laceration	none	0
	less than 1 cm in depth	I
	1 to 3 cm depth, <= 10 cm long	II
	> 3 cm in depth or > 10 cm in length	III
intraparenchymal hematoma	none	0
	<= 10 cm in diameter	II
	> 10 cm in diameter OR ruptured	III
vascular injury/bleeding	none	0
	any contained within the liver parenchyma	III
	extending beyond the liver into the peritoneum	IV
	juxtahepatic venous injury (vena cava, major hepatic veins)	V
parenchymal disruption	none	0
	less than 25% of hepatic lobe	not in table (use III)
	25 to 75% of hepatic lobe	IV
	> 75% of hepatic lobe	V
other	none	0
	capsular tear	I

If there are multiple injuries then increased grade by 1, up to Grade III (presumably refers to multiple Grade I or II lesions).

If more than one grade of injury is present then classify based by the higher/highest grade.

Vascular thrombosis can lead to organ infarction.

Vascular injury is defined as a pseudoaneurysm or arteriovenous fistula and appears as a focal collection of vascular contrast that decreases in attenuation with later images.

Active bleeding in images with contrast show an increase in size or attenuation with later images.

AAST Grade	AIS Severity
I	2
II	2
III	3
IV	4
V	5

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