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.