TY - JOUR
T1 - Evolution in the management of traumatic diaphragmatic injuries
T2 - A multicenter review
AU - Ties, Jill S.
AU - Peschman, Jacob R.
AU - Moreno, Andres
AU - Mathiason, Michelle A.
AU - Kallies, Kara J.
AU - Martin, Ronald F.
AU - Brasel, Karen J.
AU - Cogbill, Thomas H.
PY - 2014/4
Y1 - 2014/4
N2 - 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.
AB - 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.
KW - Diaphragmatic trauma
KW - blunt diaphragm injuries
KW - minimally invasive repair of traumatic diaphragmatic injury
KW - penetrating diaphragm injuries
UR - http://www.scopus.com/inward/record.url?scp=84897044117&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84897044117&partnerID=8YFLogxK
U2 - 10.1097/TA.0000000000000140
DO - 10.1097/TA.0000000000000140
M3 - Review article
C2 - 24662867
AN - SCOPUS:84897044117
SN - 2163-0755
VL - 76
SP - 1024
EP - 1028
JO - Journal of Trauma and Acute Care Surgery
JF - Journal of Trauma and Acute Care Surgery
IS - 4
ER -