Clinical evaluation of hepatic lesions: guidelines for diagnostic protocols and injury severity scores

The standardisation of diagnostic procedures according to an adequate sequence is a mandatory in determining the therapeutic strategy in liver traumas. In a series of 26 consecutive cases of trauma of the liver, 3 of them penetrating, we adopted a diagnostic algorithm based on the extensive use of sonography and "Injury Severity Scores" in addition to the standard clinical procedures. The treatment of the lesions was surgical in 21 cases (81%) and conservative in 5 (19%); post operative mortality was 14% and overall mortality 11.5%. None of the cases treated by conservative approach had to be submitted to surgery during the follow-up period. Sonography, carried out by surgical staff within 30' from observation and at definitive intervals, allowed a correct surgical approach in all cases; a similar sensitivity was obtained by sonography also in the cases treated conservatively and submitted to C.T. evaluation. The absolute correlation between Revised Trauma Score, Injury Severity Scale, classes of severity of the lesions and subsequent surgical survey suggest that this scoring system could be adopted in the first triage of traumatic lesions of the liver. Sonography could be preferred to diagnostic peritoneal lavage in the screening of cases with circulatory instability; furthermore, it could be a valid alternative to C.T. in hemodynamically stable patients.