Table 2: WSES Liver Trauma Classification with corresponding AAST liver trauma grades [9].
|
WSES grade |
Blunt/Penetrating (Stab/Guns) |
AAST |
Haemodynamic |
CT-scan |
First-line Treatment |
Minor |
WSES grade I |
B/P SW/GSW |
I- II |
Stable |
|
|
Moderate |
WSES grade II |
B/P SW/GSW |
III |
Stable |
Yes + Local Exploration in SW# |
NOM* + Serial Clinical/Laboratory/Radiological Evaluation |
Severe |
WSES grade III |
B/P SW/GSW |
IV-V |
Stable |
|
|
WSES grade IV |
B/P SW/GSW |
I- VI |
Unstable |
No |
OM |
SW: Stab Wound; GSW: Gun Shot Wound; OM: Operative Management; NOM: Non Operative Management; *NOM should only be attempted in centers capable of a precise diagnosis of the severity of liver injuries and capable of intensive management (close clinical observation and haemodynamic monitoring in a high dependency/intensive care environment, including serial clinical examination and laboratory assay, with immediate access to diagnostics, interventional radiology and surgery and immediately available access to blood and blood products); #wound exploration near the inferior costal margin should be avoided if not strictly necessary because of the high risk to damage the intercostal vessels.