title: Utility of radiographic hepatic injury grade in predicting outcome for children after blunt abdominal trauma.
abstract: OBJECTIVE
  The American Association for the Surgery of Trauma (AAST) liver injury grading system has been adopted in the management of pediatric hepatic injuries. However, the usefulness of this grading system in children remains undefined. The authors, therefore, examined the validity of AAST grading in the management of pediatric blunt liver injury.
  
  
  METHODS
  The authors identified 152 patients, ages 0 to 18 years, with blunt hepatic injury treated at our pediatric trauma center between 1995 and 2000. Radiographic AAST grade was assigned retrospectively by 2 radiologists. Variables analyzed included age, gender, Glasgow Coma Score (GCS), Injury Severity Score (ISS), and associated injuries. Outcome measures were mortality rate and length of stay (LOS). Statistical analysis was performed using analysis of variance or linear regression.
  
  
  RESULTS
  Computed tomography (CT) scans were available for 95 patients. Radiographic injury grade did not correlate with mortality rate, hospital LOS or intensive care unit (ICU) LOS. ISS and associated injury, but not age, gender, or GCS, were predictive of LOS. Grade did not correlate with mortality rate, ICU LOS, or hospital LOS.
  
  
  CONCLUSIONS
  Radiographic liver grading does not predict outcome reliably in children and should not be the main parameter utilized to guide clinical decision making. A role for scoring systems that utilize factors such as associated injuries and ISS is indicated.
authors.affiliation: Division of Pediatric Surgery, Benedum Trauma Program, The Department of Radiology Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Hackam
authors.forename: Douglas
authors.initials: D
authors.lastname: Potoka
authors.forename: Manuel
authors.initials: M
authors.lastname: Meza
authors.forename: Avrum
authors.initials: A
authors.lastname: Pollock
authors.forename: Mary
authors.initials: M
authors.lastname: Gardner
authors.forename: Peter
authors.initials: P
authors.lastname: Abrams
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Upperman
authors.forename: Laura
authors.initials: L
authors.lastname: Schall
authors.forename: Henri
authors.initials: H
authors.lastname: Ford
mesh_terms: D000007:Abdominal Injuries / Q000000981:diagnostic imaging*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015601:Injury Severity Score; D008099:Liver / Q000000981:diagnostic imaging* / Q000293:injuries*; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging*