Traumatic diaphragmatic injury: experience from a tertiary emergency medical center

Abstract

Objective: We investigated our 12-year experience of traumatic diaphragmatic injury (TDI) in our emergency medical center. This study aimed to clarify clinical features of TDI and identify factors affecting mortality and morbidity in TDI treatment.

Methods: We analyzed clinical characteristics, Injury Severity Score (ISS), probability of survival (Ps), and mortality of patients treated for TDI at the Tertiary Emergency Medical Center of Tokyo Metropolitan Bokutoh Hospital between January 1999 and December 2010.

Results: TDI occurred in 28 patients. Of 21 TDI patients (75 %) who underwent surgery, 2 died (operative mortality, 9.5 %). Seven (25 %) presented with cardiopulmonary arrest, and TDI was detected during thoracotomy in the emergency room; all of these patients died. Blunt TDI occurred in 12 patients; penetrating TDI in 16. Blunt trauma patients had significantly more injured organs (3.75 ± 0.28, P = 0.043), higher ISS (P = 0.024), and lower Ps (P = 0.048). Lengths of intensive care unit (ICU) stay and hospital stay were greater in blunt cases than in penetrating cases (P = 0.004 and P = 0.02, respectively). Non-survivors had significantly higher ISS (P < 0.001), lower Ps (P = 0.0025), and larger injured diaphragm size (8.44 ± 1.97, P = 0.048). In blunt cases, delays in diagnosis and repair of TDI led to significantly increased ICU stay (16.25 ± 3.64, P = 0.017).

Conclusion: TDI occurs in cases of multiple trauma. Higher ISS and lower Ps predict death; therefore, prompt diagnosis of TDI and immediate repair of diaphragmatic injury are important.