Guidelines for Pediatric Blunt Liver Injury | Pediatric Surgeons of Phoenix

ATOMAC Guidelines for Pediatric Blunt Liver Injury

Grades for Liver Injury
Grade	Injury Type	Description of Injury	Activity Restriction
I	Hematoma	Subcapsular, <10% surface area	2 weeks
I	Laceration	Capsular tear, <1cm parenchymal depth	2 weeks
II	Hematoma	Subcapsular, 10-50% surface area intraparenchymal <10 cm in diameter	4 weeks
II	Laceration	Capsular tear 1-3 parenchymal depth, <10 cm in depth	4 weeks
III	Hematoma	Subcapsular, >50% surface area of ruptured subcapsular or parechymal hematoma; intraparenchymal hematoma >10cm or expanding	5 weeks
III	Laceration	>3 cm parenchymal depth	5 weeks
IV	Laceration	Parenchymal disruption involving 25-75% hepatic lobe or 1-3	6 weeks
V	Laceration	Parenchymal disruption involving 75% of hepatic lobe or >3 Couinaud’s segments	8 weeks
V	Vascular	Juxtahepatic venous injuries	8 weeks
VI	Vascular	Hepatic avulsion	8 weeks

ATOMAC refers to the Arizona-Texas-Oklahoma-Memphis-Arkansas-Consortium of Pediatric Level I Trauma Centers.