Journal of Trauma and Injury

The Korean Society of Traumatology (대한외상학회)
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Comparison of Penetrating and Blunt Traumatic Diaphragmatic Injuries

  • Lee, Sang Su (Department of Emergency Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine) ;
  • Hyun, Sung Youl (Department of Traumatology, Gachon University Gil Medical Center, Gachon University College of Medicine) ;
  • Yang, Hyuk Jun (Department of Emergency Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine) ;
  • Lim, Yong Su (Department of Emergency Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine) ;
  • Cho, Jin Seong (Department of Emergency Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine) ;
  • Woo, Jae Hyug (Department of Emergency Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine)
  • Received : 2019.09.16
  • Accepted : 2019.10.29
  • Published : 2019.12.30
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Abstract

Purpose: Traumatic diaphragmatic injury (TDI) is no longer considered to be a rare condition in Korea. This study investigated differences in the prevalence of accompanying injuries and the prognosis in patients with traumatic diaphragmatic damage according to the mechanism of injury. Methods: We retrospectively reviewed the medical records of patients with TDI who were seen at a regional emergency medical center from January 2000 to December 2018. Among severe trauma patients with traumatic diaphragmatic damage, adults older than 18 years of age with a known mechanism of injury were included in this study. Surgery performed within 6 hours after the injury was sustained was defined as emergency surgery. We assessed the survival rate and likelihood of respiratory compromise according to the mechanism of injury. Results: In total, 103 patients were analyzed. The patients were categorized according to whether they had experienced a penetrating injury or a blunt injury. Thirty-five patients had sustained a penetrating injury, and traffic accidents were the most common cause of blunt injuries. The location of the injury did not show a statistically significant difference between these groups. Severity of TDI was more common in the blunt injury group than in the penetrating injury group, and was also more likely in patients with respiratory compromise. However, sex, the extent of damage, and the initial Glasgow coma scale score had no significant relationship with severity. Conclusions: Based on the findings of this study, TDI should be recognized and managed proactively in patients with blunt injury and/or respiratory compromise. Early recognition and implementation of an appropriate management strategy would improve patients' prognosis. Multi-center, prospective studies are needed in the future.

Keywords

References

  1. Rosati C. Acute traumatic injury of the diaphragm. Chest Surg Clin N Am 1998;8:371-9.
  2. Scharff JR, Naunheim KS. Traumatic diaphragmatic injuries. Thorac Surg Clin 2007;17:81-5. https://doi.org/10.1016/j.thorsurg.2007.03.006
  3. Meyers BF, McCabe CJ. Traumatic diaphragmatic hernia. Occult marker of serious injury. Ann Surg 1993;218:783-90. https://doi.org/10.1097/00000658-199312000-00013
  4. Rizoli SB, Brenneman FD, Boulanger BR, Maggisano R. Blunt diaphragmatic and thoracic aortic rupture: an emerging injury complex. Ann Thorac Surg 1994;58:1404-8. https://doi.org/10.1016/0003-4975(94)91923-2
  5. Fair KA, Gordon NT, Barbosa RR, Rowell SE, Watters JM, Schreiber MA. Traumatic diaphragmatic injury in the American College of Surgeons National Trauma Data Bank: a new examination of a rare diagnosis. Am J Surg 2015;209:864-9. https://doi.org/10.1016/j.amjsurg.2014.12.023
  6. Lopez PP, Arango J, Gallup TM, Cohn SM, Myers J, Corneille M, et al. Diaphragmatic injuries: what has changed over a 20-year period? Am Surg 2010;76:512-6. https://doi.org/10.1177/000313481007600520
  7. Kim Y. A clinical analysis of traumatic diaphragmatic injury. J Korean Soc Traumatol 2004;17:67-73.
  8. Beal SL, Mckennan M. Blunt diaphragm rupture. A morbid injury. Arch Surg 1988:123;828-32. https://doi.org/10.1001/archsurg.1988.01400310042007
  9. Estrera AS, Platt MR, Mills LJ. Traumatic injuries of the diaphragm. Chest 1979;75:306-13. https://doi.org/10.1378/chest.75.3.306
  10. Wise L, Connors J, Hwang YH, Anderson C. Traumatic injuries to the diaphragm. J Trauma 1973;13:946-50. https://doi.org/10.1097/00005373-197311000-00002
  11. Griswold FW, Worden HE, Gardner RJ. Acute diaphragmatic rupture caused by blunt trauma. Am J Surg 1972;124:359-62. https://doi.org/10.1016/0002-9610(72)90041-4
  12. Shah R, Sabanathan S, Mearns AJ, Choudhury AK. Traumatic rupture of diaphragm. Ann Thorac Surg 1995;60:1444-9. https://doi.org/10.1016/0003-4975(95)00629-Y
  13. Morgan BS, Watcyn-Jones T, Garner JP. Traumatic diaphragmatic injury. J R Army Med Corps 2012;156:139-44.
  14. de la Rocha AG, Creel RJ, Mulligan GW, Burns CM. Diaphragmatic rupture due to blunt abdominal trauma. Surg Gynecol Obstet 1982;154:175-80.
  15. Estrera AS, Landay MJ, McClelland RN. Blunt traumatic rupture of the right hemidiaphragm: experience in 12 patients. Ann Thorac Surg 1985;39:525-30. https://doi.org/10.1016/s0003-4975(10)61992-3
  16. Drews JA, Mercer EC, Benfield JR. Acute diaphragmatic injuries. Ann Thorac Surg 1973;16:67-78. https://doi.org/10.1016/s0003-4975(10)65813-4
  17. Duzgun AP, Ozmen MM, Saylam B, Coskun F. Factors influencing mortality in traumatic ruptures of diaphragm. Ulus Travma Acil Cerrahi Derg 2008;14:132-8.
  18. Ozguc H, Akkose S, Sen G, Bulut M, Kaya E. Factors affecting mortality and morbidity after traumatic diaphragmatic injury. Surgery Today 2007;37:1042-6. https://doi.org/10.1007/s00595-007-3545-1
  19. Guth AA, Pachter HL, Kim U. Pitfalls in the diagnosis of blunt diaphragmatic injury. Am J Surg 1995;170:5-9. https://doi.org/10.1016/S0002-9610(99)80242-6
  20. Haciibrahimoglu G, Solak O, Olcmen A, Bedirhan MA, Solmazer N, Gurses A. Management of traumatic diaphragmatic rupture. Surg Today 2004;34:111-4. https://doi.org/10.1007/s00595-003-2662-8
  21. Adegboye VO, Ladipo JK, Adebo OA, Brimmo AI. Diaphragmatic injuries. Afr J Med Med Sci 2002;31:149-53.
  22. Matsevych OY. Blunt diaphragmatic rupture: four year's experience. Hernia 2008;12:73-8. https://doi.org/10.1007/s10029-007-0283-7
  23. Shehata SM, Shabaan BS. Diaphragmatic injuries in children after blunt abdominal trauma. J Pediatr Surg 2006;41:1727-31. https://doi.org/10.1016/j.jpedsurg.2006.05.047
  24. Van Vugt AB, Schoots FJ. Acute diaphragmatic rupture due to blunt trauma: a retrospective analysis. J Trauma 1989;29:683-6. https://doi.org/10.1097/00005373-198905000-00025
  25. Andrus CH, Morton JH. Rupture of the diaphragm after blunt trauma. Am J Surg 1970;119:686-93. https://doi.org/10.1016/0002-9610(70)90240-0
  26. Ebert PA, Gaertner RA, Zuidema GD. Traumatic diaphragmatic hernia. Surg Gynecol Obstet 1967;125:59-65.
  27. Karmy-Jones R, Jurkovich GJ. Blunt chest trauma. Curr Probl Surg 2004;41:211-380. https://doi.org/10.1016/j.cpsurg.2003.12.003
  28. Dunham CM, Barraco RD, Clark DE, Daley BJ, Davis FE 3rd, Gibbs MA, et al. Guidelines for emergency tracheal intubation immediately after traumatic injury. J Trauma 2003;55:162-79. https://doi.org/10.1097/01.ta.0000083335.93868.2c
  29. Jung K, Lee CJ, Kim J. Injury severity scoring system for trauma patients and trauma outcomes research in Korea. J Acute Care Surg 2016;6:11-7. https://doi.org/10.17479/jacs.2016.6.1.11
  30. Watkins TR, Nathens AB, Cooke CR, Psaty BM, Maier RV, Cuschieri J, et al. Acute respiratory distress syndrome after trauma: development and validation of a predictive model. Crit Care Med 2012;40:2295-303. https://doi.org/10.1097/CCM.0b013e3182544f6a

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