AUTHO RS
Stanford M. Goldman, MD
O. Clark West, MD
This publication is designed to offer information suitable for use by an appropriately trained physician.
The information provided is not intended to be comprehensive or to offer a defined standard of care. 2014 American College of Surgeons
The user agrees to release and idemnify the American College of Surgeons from claims arising from use of the publication.
OR G A N I N J URY S C AL E L I VE R INJU RY S PLE E N INJU RY PAG E 2
AUTHO RS
Stanford M. Goldman, MD
O. Clark West, MD
This publication is designed to offer information suitable for use by an appropriately trained physician.
The information provided is not intended to be comprehensive or to offer a defined standard of care. 2014 American College of Surgeons
The user agrees to release and idemnify the American College of Surgeons from claims arising from use of the publication.
OR G A N I N J URY S C AL E L I V E R INJU RY S PLE E N INJU RY PAGE 3
Liver Injury Scaling
Right Hemiliver (Right Liver) Left Hemiliver (Left Liver)
Liver Injury Images
Inferior Vena Cava Middle Heptic Vein
All Liver Injury Statistics
Right Heptic Vein Left Heptic Vein
Isolated Liver Injury Statistics
Falciform
Ligament
5
Portal Vein
6 Common
Heptic Artery
Common
Bile Duct
GRADE* I N J U RY D E S C R I P TI O N ICD -9 AIS 90
Liver Injury Images 864.01
All Liver Injury Statistics Subcapsular hematoma, <10% surface area; Capsular tear, <1 cm
parenchymal depth
864.11
864.02
864.12
2
*Advance one grade for multiple injuries, up to grade From Moore EE, Cogbill
TH, Jurkovich GJ, et al. Organ injury scaling V: Spleen and liver (1994 revision).
J Trauma. 1995;38:323. With permission. NTDB VERSION 8-11
All Liver Injury Statistics
M O R TA L I T Y
Isolated Liver Injury Statistics
40%
Liver Injuries-Mortality
Liver Injuries-OR
20%
Liver Injuries-LOS
Liver Injuries-ICU
0%
1 & 2 3 4 5 6 TOTA L
OIS GRADE
OR
Isolated Liver Injury Statistics
Liver Injuries-Mortality
Liver Injuries-OR
Liver Injuries-LOS 10%
Liver Injuries-ICU
0%
1 & 2 3 4 5 6 TOTA L
OIS GRADE
L O S ( DAYS )
Isolated Liver Injury Statistics
12
Isolated Liver Injury without
Severe Head Trauma Statistics
10
Isolated Liver Injury without
Severe Head Trauma or Early
Death 24 Hours Statistics 8
6
Liver Injuries-Mortality
Liver Injuries-OR
4
Liver Injuries-LOS
Liver Injuries-ICU
2
0
1 & 2 3 4 5 6 TOTA L
OIS GRADE
LI V E R I N J U R I E S - I C U
Liver Anatomy Overview
12
I C U ( DAYS )
Liver Injury Scaling
Liver Injuries-Mortality
2
Liver Injuries-OR
Liver Injuries-LOS
0
Liver Injuries-ICU
1 & 2 3 4 5 6 TOTA L
OIS GRADE
5. Mortality: OIS Grades 1 & 2 = OIS Grade 3 < OIS Grade 4 < OIS Grade 5 < OIS Grade 6.
6. OR: OIS Grade 1 & 2 = OIS Grade 3 < OIS Grade 4 = OIS Grade 5 = OIS Grade 6.
7. LOS: OIS Grade 6 < OIS Grade 1 & 2 = OIS Grade 3 = OIS Grade 4 = OIS Grade 5.
8. ICU LOS: OIS Grade 6 < OIS Grade 1 & 2 = OIS Grade 3 = OIS Grade 4 = OIS Grade 5. NTDB VERSION 8-11
M O R TA L I T Y
Isolated Liver Injury Statistics
90%
Isolated Liver Injury without
Severe Head Trauma Statistics 80%
50%
Liver Injuries-Mortality
Liver Injuries-OR 40%
Liver Injuries-LOS
30%
Liver Injuries-ICU
20%
10%
0%
1 & 2 3 4 5 6 TOTA L
OIS GRADE
OR
Isolated Liver Injury Statistics
Liver Injuries-OR
Liver Injuries-LOS
10%
Liver Injuries-ICU
5%
0%
1 & 2 3 4 5 6 TOTA L
OIS GRADE
L O S ( DAYS )
Isolated Liver Injury Statistics
6
Liver Injuries-Mortality
Liver Injuries-OR
Liver Injuries-LOS 4
Liver Injuries-ICU
0
1 & 2 3 4 5 6 TOTA L
OIS GRADE
I S O L AT E D LI V E R I N J U R I E S - I C U
Liver Anatomy Overview
9
I C U ( DAYS )
Liver Injury Scaling
8
Liver Injury Images
Liver Injuries-Mortality 2
Liver Injuries-OR
1
Liver Injuries-LOS
Liver Injuries-ICU 0
1 & 2 3 4 5 6 TOTA L
OIS GRADE
1. Mortality: OIS Grades 1 & 2 = OIS Grade 3 < OIS Grade 4 < OIS Grade 5 < OIS Grade 6.
2. OR: OIS Grade 1 & 2 = OIS Grade 3 < OIS Grade 4 = OIS Grade 5 = OIS Grade 6.
3. LOS: OIS Grade 6 < OIS Grade 1 & 2 = OIS Grade 3 = OIS Grade 4 = OIS Grade 5.
4. ICU LOS: OIS Grade 6 < OIS Grade 1 & 2 = OIS Grade 3 = OIS Grade 4 = OIS Grade 5. NTDB VERSION 8-11
M O R TA L I T Y
Isolated Liver Injury Statistics
90%
Isolated Liver Injury without
Severe Head Trauma Statistics 80%
50%
Liver Injuries-Mortality
40%
Liver Injuries-OR
30%
Liver Injuries-LOS
Liver Injuries-ICU 20%
10%
0%
1 & 2 3 4 5 6 TOTA L
OIS GRADE
OR
Isolated Liver Injury Statistics
Liver Injuries-Mortality
Liver Injuries-OR 10%
Liver Injuries-LOS
Liver Injuries-ICU
5%
0%
1 & 2 3 4 5 6 TOTA L
OIS GRADE
LOS
Isolated Liver Injury Statistics
Liver Injuries-Mortality
Liver Injuries-OR 4
Liver Injuries-LOS
Liver Injuries-ICU
2
0
1 & 2 3 4 5 6 TOTA L
OIS GRADE
I S O L AT E D LI V E R I N J U R I E S
Liver Anatomy Overview W/O S E V E R E H E A D T R AU M A - I C U
ICU
Liver Injury Images
8
All Liver Injury Statistics
7
Isolated Liver Injury Statistics
6
Isolated Liver Injury without
Severe Head Trauma Statistics
5
Liver Injuries-Mortality 2
Liver Injuries-OR 1
Liver Injuries-LOS
0
Liver Injuries-ICU 1 & 2 3 4 5 6 TOTA L
OIS GRADE
1. Mortality: OIS Grades 1 & 2 = OIS Grade 3 < OIS Grade 4 < OIS Grade 5 < OIS Grade 6.
2. OR: OIS Grade 1 & 2 = OIS Grade 3 < OIS Grade 4 = OIS Grade 5 = OIS Grade 6.
3. LOS: OIS Grades 6 < OIS Grades 1&2 = OIS Grade 3 = OIS Grade 4 = OIS Grade 5.
4. ICU LOS: OIS Grades 6 < OIS Grades 1&2 = OIS Grade 3 = OIS Grade 4 = OIS Grade 5. NTDB VERSION 8-11
M O R TA L I T Y
Isolated Liver Injury Statistics
Liver Injuries-OR
Liver Injuries-LOS 20%
Liver Injuries-ICU
10%
0%
1 & 2 3 4 5 6 TOTA L
OIS GRADE
OR
Isolated Liver Injury Statistics
Liver Injuries-Mortality
Liver Injuries-OR 10%
Liver Injuries-LOS
Liver Injuries-ICU
5%
0%
1 & 2 3 4 5 6 TOTA L
OIS GRADE
L O S ( DAYS )
Isolated Liver Injury Statistics
16
Isolated Liver Injury without
Severe Head Trauma Statistics 14
Liver Injuries-Mortality 8
Liver Injuries-OR
6
Liver Injuries-LOS
4
Liver Injuries-ICU
2
0
1 & 2 3 4 5 6 TOTA L
OIS GRADE
I S O L AT E D LI V E R I N J U R I E S W/O S E V E R E H E A D T R AU M A
Liver Anatomy Overview O R E A R LY D E AT H 24 HOURS - ICU
I C U ( DAYS )
Liver Injury Images
9
All Liver Injury Statistics
8
2
Liver Injuries-Mortality
1
Liver Injuries-OR
Liver Injuries-LOS 0
1 & 2 3 4 5 6 TOTA L
Liver Injuries-ICU OIS GRADE
1. Mortality: OIS Grades 6 > OIS Grades 1 & 2 = OIS Grade 3 = OIS Grade 4 = OIS Grade 5.
2. OR: OIS Grade 1 & 2 < OIS Grade 3 < OIS Grade 4 = OIS Grade 5.
3. LOS: Equivalent (p = 0.169).
4. ICU LOS: Equivalent (p = 0.445).
- AIS 90 codes: {541899.2, 541810.2, 541812.2, 541820.2, 541822.2, 541814.3, 541824.3, 541826.4, 541828.5, 541830.6}
- Operative procedures related to the liver injury ICD-9 codes: 50.00-50.99.
- Significance level set at < 0.025. NTDB VERSION 8-11
AUTHO RS
Stanford M. Goldman, MD
O. Clark West, MD
This publication is designed to offer information suitable for use by an appropriately trained physician.
The information provided is not intended to be comprehensive or to offer a defined standard of care. 2014 American College of Surgeons
The user agrees to release and idemnify the American College of Surgeons from claims arising from use of the publication.
OR G A N I N J URY S C AL E L I V E R INJU RY S PLE E N INJU RY PAGE 3 1
Isolated Spleen Injury without Subcapsular hematoma, 10%50% surface area; intraparenchymal, <5 cm in diameter; 865.01
Severe Head Trauma or Early
Death 24 Hours Statistics laceration 13 cm parenchymal depth, <10 cm in length which does not involve a
trabecular vessel
865.11
865.03
865.13
2
Completely shattered spleen; hilar vascular injury which devascularizes spleen 865.04
865.14
5
*Advance one grade for multiple injuries, up to grade From Moore EE, Cogbill TH,
Jurkovich GJ, et al. Organ injury scaling V: Spleen and liver (1994 revision).
J Trauma. 1995;38:323. With permission.
( W IT H E X T R AVA SATI O N)
( W IT H O U T E X T R AVA SATI O N)
865.04
Completely shattered spleen; hilar vascular injury which devascularizes spleen
865.14
5
Spleen Anatomy
M O R TA L I T Y
Isolated Spleen Injury without
Severe Head Trauma Statistics
10%
Spleen Injuries-Mortality
Spleen Injuries-OR
Spleen Injuries-LOS 5%
Spleen Injuries-ICU
0%
1 & 2 3 4 5 TOTA L
OIS GRADE
Spleen Anatomy
OR
All Spleen Injury Statistics
30%
Spleen Injuries-Mortality
Spleen Injuries-OR 20%
Spleen Injuries-LOS
Spleen Injuries-ICU 10%
0%
1 & 2 3 4 5 TOTA L
OIS GRADE
Spleen Anatomy
L O S ( DAYS )
Isolated Spleen Injury without
Severe Head Trauma Statistics 12
Spleen Injuries-Mortality 6
Spleen Injuries-OR
Spleen Injuries-LOS 4
Spleen Injuries-ICU
2
0
1 & 2 3 4 5 TOTA L
OIS GRADE
I C U ( DAYS )
All Spleen Injury Statistics 8
2
Spleen Injuries-Mortality
Spleen Injuries-OR 1
Spleen Injuries-LOS 0
1. Mortality: OIS Grade 3 < OIS Grade 1 & 2 = OIS Grade 4 < OIS Grade 5.
2. OR: OIS Grades 1 & 2 < OIS Grade 3 < OIS Grade 4 < OIS Grade 5.
3. LOS: OIS Grades 1&2 = OIS Grade 3 = OIS Grade 4 < OIS Grade 5.
4. ICU LOS: OIS Grade 3 < OIS Grade 4 = OIS Grade 1 & 2 < OIS Grade 5.
NTDB VERSION 8-11
Spleen Anatomy
M O R TA L I T Y
Isolated Spleen Injury without
Severe Head Trauma Statistics
Spleen Injuries-Mortality
Spleen Injuries-OR 5%
Spleen Injuries-LOS
Spleen Injuries-ICU
0%
1 & 2 3 4 5 TOTA L
OIS GRADE
Spleen Anatomy
OR
Isolated Spleen Injury without
Severe Head Trauma Statistics 50%
30%
Spleen Injuries-Mortality
Spleen Injuries-OR 20%
Spleen Injuries-LOS
Spleen Injuries-ICU 10%
0%
1 & 2 3 4 5 TOTA L
OIS GRADE
Spleen Anatomy
L O S ( DAYS )
Isolated Spleen Injury without
Severe Head Trauma Statistics
10
Isolated Spleen Injury without
Severe Head Trauma or Early
Death 24 Hours Statistics 8
Spleen Injuries-Mortality
Spleen Injuries-OR 4
Spleen Injuries-LOS
Spleen Injuries-ICU 2
0
1 & 2 3 4 5 TOTA L
OIS GRADE
Spleen Anatomy
I C U ( DAYS )
All Spleen Injury Statistics
2
Spleen Injuries-Mortality
Spleen Injuries-OR 1
Spleen Injuries-LOS
Spleen Injuries-ICU 0
1 & 2 3 4 5 TOTA L
OIS GRADE
1. Mortality: OIS Grade 3 < OIS Grade 1 & 2 = OIS Grade 4 < OIS Grade 5.
2. OR: OIS Grade 1 & 2 < OIS Grade 3 < OIS Grade 4 < OIS Grade 5.
3. LOS: OIS Grade 1 & 2 = OIS Grade 3 = OIS Grade 4 < OIS Grade 5.
4. ICU LOS: OIS Grade 3 = OIS Grade 4 < OIS Grade 1 & 2 = OIS Grade 5.
NTDB VERSION 8-11
Spleen Anatomy
M O R TA L I T Y
Isolated Spleen Injury without
Severe Head Trauma Statistics
8%
Isolated Spleen Injury without
Severe Head Trauma or Early
Death 24 Hours Statistics 6%
4%
Spleen Injuries-Mortality
Spleen Injuries-OR
2%
Spleen Injuries-LOS
Spleen Injuries-ICU
0%
1 & 2 3 4 5 TOTA L
OIS GRADE
Spleen Anatomy
OR
60%
Spleen Injuries-OR
Spleen Injuries-LOS 10%
Spleen Injuries-ICU
0%
1 & 2 3 4 5 TOTA L
OIS GRADE
Spleen Anatomy
L O S ( DAY )
Isolated Spleen Injury without
Severe Head Trauma Statistics 10
Spleen Injuries-Mortality 4
Spleen Injuries-OR
Spleen Injuries-LOS 2
Spleen Injuries-ICU
0
1 & 2 3 4 5 TOTA L
OIS GRADE
Spleen Anatomy
ICU
Isolated Spleen Injury Statistics
6
Spleen Injuries-Mortality
1
Spleen Injuries-OR
Spleen Injuries-LOS 0
1 & 2 3 4 5 TOTA L
Spleen Injuries-ICU
OIS GRADE
1. Mortality: OIS Grade 3 < OIS Grade 1 & 2 = OIS Grade 4 < OIS Grade 5.
2. OR: OIS Grade 1 & 2 < OIS Grade 3 < OIS Grade 4 < OIS Grade 5.
3. LOS: OIS Grade 1 & 2 = OIS Grade 3 < OIS Grade 4 < OIS Grade 5.
4. ICU LOS: OIS Grade 3 < OIS Grade 4 = OIS Grade 1 & 2 < OIS Grade
Spleen Anatomy
M O R TA L I T Y
Isolated Spleen Injury without 3.5%
Severe Head Trauma Statistics
3%
Isolated Spleen Injury without
Severe Head Trauma or Early
2.5%
Death 24 Hours Statistics
2%
1.5%
Spleen Injuries-Mortality
Spleen Injuries-OR 1%
Spleen Injuries-LOS
0.5%
Spleen Injuries-ICU
0%
1 & 2 3 4 5 TOTA L
OIS GRADE
Spleen Anatomy
OR
Isolated Spleen Injury without
Severe Head Trauma Statistics 50%
Spleen Injuries-OR
10%
Spleen Injuries-LOS
Spleen Injuries-ICU
0%
1 & 2 3 4 5 TOTA L
OIS GRADE
Spleen Anatomy
L O S ( DAYS )
Isolated Spleen Injury without
Severe Head Trauma Statistics 10
Spleen Injuries-Mortality 4
Spleen Injuries-OR
2
Spleen Injuries-LOS
Spleen Injuries-ICU
0
1 & 2 3 4 5 TOTA L
OIS GRADE
Spleen Anatomy
I C U ( DAYS )
Isolated Spleen Injury Statistics
6
Isolated Spleen Injury without
Severe Head Trauma Statistics 5
Spleen Injuries-Mortality 1
Spleen Injuries-OR
0
Spleen Injuries-LOS 1 & 2 3 4 5 TOTA L
1. Mortality: OIS Grade 1 & 2 = OIS Grade 3 = OIS Grade 4 < OIS Grade 5.
2. OR: OIS Grade 1 & 2 < OIS Grade 3 < OIS Grade 4 < OIS Grade 5.
3. LOS: OIS Grade 3 < OIS Grade 1 & 2 = OIS Grade 4 < OIS Grade 5.
4. ICU LOS: OIS Grade 3 < OIS Grade 4 = OIS Grades 1 & 2 < OIS Grade 5.
- AIS 90 codes: {544299.2, 544210.2, 544212.2, 544220.2, 544222.2, 544214.3, 544244.3, 544226.4, 544228.5}
- Operative procedures related to the spleen injury ICD-9 codes: 41.00-41.99.
- Significance level set at < 0.025.
NTDB VERSION 8-11