Skip to main content
Log in

Traumatic diaphragmatic injury: experience from a tertiary emergency medical center

  • Original Article
  • Published:
General Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

Explore related subjects

Discover the latest articles and news from researchers in related subjects, suggested using machine learning.

References

  1. Meyers BF, McCabe CJ. Traumatic diaphragmatic hernia. Occult marker of serious injury. Ann Surg. 1993;218:783–90.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Beauchamp G, Khalfallah A, Girard R, Dube S, Laurendeau F, Legros G. Blunt diaphragmatic rupture. Am J Surg. 1984;148:292–5.

    Article  CAS  PubMed  Google Scholar 

  3. Kole KL. Traumatic diaphragmatic injuries. Trauma Q. 2002;15:109–20.

    Google Scholar 

  4. Arsensio JA, Demetriades D, Rodriguez A. Injury to the diaphragm. In: Mattox KL, Feliciano DV, Moore EE, editors. Trauma. 4th ed. New York: McGraw-Hill; 2000. p. 603–32.

    Google Scholar 

  5. Rosati C. Acute traumatic injury of the diaphragm. Chest Surg Clin N Am. 1998;8:371–9.

    CAS  PubMed  Google Scholar 

  6. Kearney PA, Rouhana SW, Burney RE. Blunt rupture of the diaphragm: mechanism, diagnosis, and treatment. Ann Emerg Med. 1989;18:1326–30.

    Article  CAS  PubMed  Google Scholar 

  7. Grage TB, Maclean LD, Campbell GS. Traumatic rupture of the diaphragm: a report of 26 cases. Surgery. 1959;46:669–81.

    CAS  PubMed  Google Scholar 

  8. Estrera AS, Platt MR, Mills LJ. Traumatic injuries of the diaphragm. Chest. 1979;75:306–13.

    Article  CAS  PubMed  Google Scholar 

  9. Degiannis E, Levy RD, Sofianos C, Potokar T, Florizoone MG, Saadia R. Diaphragmatic herniation after penetrating trauma. Br J Surg. 1996;83:88–91.

    Article  CAS  PubMed  Google Scholar 

  10. Brasel KJ, Borgstrom DC, Meyer P, Weigelt JA. Predictors of outcome in blunt diaphragm rupture. J Trauma. 1996;41:484–7.

    Article  CAS  PubMed  Google Scholar 

  11. Dirican A, Yilmaz M, Unal B, Piskin T, Ersan V, Yilmaz S. Acute traumatic diaphragmatic ruptures: a retrospective study of 48 cases. Surg Today. 2011;41:1352–6.

    Article  PubMed  Google Scholar 

  12. Baker SP, O’Neill B, Haddon W Jr, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14:187–96.

    Article  CAS  PubMed  Google Scholar 

  13. Champion HR, Sacco WJ, Copes WS, Gann DS, Gennarelli TA, Flanagan ME. A revision of the Trauma Score. J Trauma. 1989;29:623–9.

    Article  CAS  PubMed  Google Scholar 

  14. Boyd CR, Tolson MA, Copes WS. Evaluating trauma care: the TRISS method. Trauma Score and the Injury Severity Score. J Trauma. 1987;27:370–8.

    Article  CAS  PubMed  Google Scholar 

  15. Kawaguchi H, Kawahara K. Study regarding accessibility to emergency medical care centers: results from the GIS simulation. J Jpn Soc Hosp Admin. 2006;43:35–46.

    Google Scholar 

  16. Cho Y, Hishiyama H, Ikeda J, Nakamura Y, Suzuoki M, Shibano N. A study of traumatic rupture of the diaphragm. J Jpn Surgical Assoc. 2001;62:924–8.

    Article  Google Scholar 

  17. Ozgüç H, Akköse S, Sen G, Bulut M, Kaya E. Factors affecting mortality and morbidity after traumatic diaphragmatic injury. Surg Today. 2007;37:1042–6.

    Article  PubMed  Google Scholar 

  18. Hanna WC, Ferri LE, Fata P, Razek T, Mulder DS. The current status of traumatic diaphragmatic injury: lessons learned from 105 patients over 13 years. Ann Thorac Surg. 2008;85:1044–8.

    Article  PubMed  Google Scholar 

  19. Lewis JD, Starnes SL, Pandalai PK, Huffman LC, Bulcao CF, Pritts TA. Traumatic diaphragmatic injury: experience from a level I trauma center. Surgery. 2009;146:578–83.

    Article  PubMed  Google Scholar 

  20. Tiberio GA, Portolani N, Coniglio A, Baiocchi GL, Vettoretto N, Giulini SM. Traumatic lesions of the diaphragm. Our experience in 33 cases and review of the literature. Acta Chir Belg. 2005;105:82–8.

    CAS  PubMed  Google Scholar 

  21. Johnson CD. Blunt injuries of the diaphragm. Br J Surg. 1988;75:226–30.

    Article  CAS  PubMed  Google Scholar 

  22. Maddox PR, Mansel RE, Butchart EG. Traumatic rupture of the diaphragm: a difficult diagnosis. Injury. 1991;22:299–302.

    Article  CAS  PubMed  Google Scholar 

  23. Boulanger BR, Kearney PA, Tsuei B, Ochoa JB. The routine use of sonography in penetrating torso injury is beneficial. J Trauma. 2001;51:320–5.

    Article  CAS  PubMed  Google Scholar 

  24. Broos PL, Rommens PM, Carlier H, Van Leeuwen JE, Somville FJ, Gruwez JA. Traumatic rupture of the diaphragm. Review of 62 successive cases. Int Surg. 1989;74:88–92.

    CAS  PubMed  Google Scholar 

  25. Cayten CG, Stahl WM, Agarwal N, Murphy JG. Analyses of preventable deaths by mechanism of injury among 13,500 trauma admissions. Ann Surg. 1991;214:510–20.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Feliciano DV, Cruse PA, Mattox KL, Bitondo CG, Burch JM, Noon GP. Delayed diagnosis of injuries to the diaphragm after penetrating wounds. J Trauma. 1988;28:1135–44.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Masahiko Okada.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Okada, M., Adachi, H., Kamesaki, M. et al. Traumatic diaphragmatic injury: experience from a tertiary emergency medical center. Gen Thorac Cardiovasc Surg 60, 649–654 (2012). https://doi.org/10.1007/s11748-012-0132-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11748-012-0132-1

Keywords