Western Trauma Association
Management of Adult Blunt Hepatic Trauma
Annotation
for Point F
A
CT scan of the abdomen is the optimal diagnostic
modality to aide in both the diagnosis and management of
blunt hepatic trauma in hemodynamically stable patients.22
Liver injuries are graded per the American Association
for the Surgery of Trauma liver injury scale, which was
developed as part of the transition to nonoperative
management and remains valid today.23 A
recent report using data from the National Trauma Data
Bank demonstrated that increasing injury severity was
associated with increasing organ injury scale grades.12
In addition, organ-specific operative rates increased
with increasing grade, although grade alone did not
accurately predict the need for operation. When patients
with isolated liver injuries were analyzed, 91.5% of
grade I and II injuries, 79% of grade III, 72.8% of
grade 4, and 62.6% of grade 5 injuries were successfully
managed without operative intervention. Therefore, even
high-grade injuries have a high likelihood of successful
nonoperative management.
