Evolution in the management of traumatic diaphragmatic injuries: A multicenter review

Jill S. Ties, Jacob R. Peschman, Andres Moreno, Michelle A. Mathiason, Kara J. Kallies, Ronald F. Martin, Karen J. Brasel, Thomas H. Cogbill

Research output: Contribution to journalReview article

16 Scopus citations

Abstract

Background: Traumatic diaphragmatic injury (TDI) is uncommon and has historically been identified by chest x-ray and repaired by laparotomy with nonabsorbable suture. Blunt TDI was more frequently (90%) detected on the left. With advances in imaging and operative techniques, our objective was to evaluate evolution in incidence, location, and management of TDI. Methods: The medical records of patients admitted to three Wisconsin regional trauma centers with TDI from 1996 to 2011 were reviewed. Patients were stratified into blunt and penetrating injury and early (1996-2003) and recent (2004-2011) periods. p < 0.05 was significant. Results: A total of 454 patients was included, 87% were men. Median Injury Severity Score (ISS) was 22 and 19 in the early and recent periods, respectively. Diagnostic modality for TDI did not change over time when comparing chest x-ray, computed tomography, or intraoperative diagnosis for blunt (p = 0.214) or penetrating (p = 0.119) TDI. More right-sided penetrating TDI were identified in the recent versus early group (49% vs. 27%). Perihiatal injury was rare (2%). Minimally invasive repairs increased in the recent versus early group of penetrating TDI (5.8% vs. 0.9%, p = 0.040). Complex repairs (mesh, transposition) were required in only three patients. In-hospital mortality was 15% and 4% for blunt and penetrating TDIs, respectively (p < 0.001). Conclusion: A large increase in the frequency of both blunt and penetrating TDIs in our region was documented. While no difference was observed regarding diagnosis of blunt TDI during the two study periods, our data show a change from historical reports; more injuries were detected by computed tomography. An increase in right-sided penetrating TDI was also observed. A small but previously unreported incidence of perihiatal/pericardial injury occurred with both blunt and penetrating TDIs. While the majority of injuries were repaired with laparotomy, minimally invasive repairs were used more frequently in the recent period. LEVEL OF EVIDENCE: Epidemiologic study, level III. Therapeutic study, level IV.

Original languageEnglish (US)
Pages (from-to)1024-1028
Number of pages5
JournalJournal of Trauma and Acute Care Surgery
Volume76
Issue number4
DOIs
StatePublished - Apr 2014

Keywords

  • Diaphragmatic trauma
  • blunt diaphragm injuries
  • minimally invasive repair of traumatic diaphragmatic injury
  • penetrating diaphragm injuries

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

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    Ties, J. S., Peschman, J. R., Moreno, A., Mathiason, M. A., Kallies, K. J., Martin, R. F., Brasel, K. J., & Cogbill, T. H. (2014). Evolution in the management of traumatic diaphragmatic injuries: A multicenter review. Journal of Trauma and Acute Care Surgery, 76(4), 1024-1028. https://doi.org/10.1097/TA.0000000000000140