Non-Operative Management of Adult Blunt
Hepatic Trauma Algorithm
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.