Liver trauma injury grading

The AAST (American Association for the Surgery of Trauma) liver injury grading system for liver trauma is:

  • grade I
    • haematoma: subcapsular, <10% surface area
    • laceration: capsular tear, <1 cm depth
  • grade II
    • haematoma: subcapsular, 10-50% surface area
    • haematoma: intraparenchymal <10 cm diameter
    • laceration: capsular tear, 1-3 cm depth, <10 cm length
  • grade III
    • haematoma: subcapsular, >50% surface area, or ruptured with active bleeding
    • haematoma: intraparenchymal >10 cm diameter
    • laceration: capsular tear, >3 cm depth
  • grade IV
    • haematoma: ruptured intraparenchymal with active bleeding
    • laceration: parenchymal disruption involving 25-75% hepatic lobe or involves 1-3 Couinaud segments (within one lobe)
  • grade V
    • laceration: parenchymal disruption involving >75% of hepatic lobe or involves >3 Couinaud segments (within one lobe)
    • vascular: juxtahepatic venous injuries (inferior vena cava, major hepatic vein)
  • grade VI
    • vascular: hepatic avulsion

NB Advance one grade for multiple injuries up to grade III

See also

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