Presentations and outcomes in patients with traumatic diaphragmatic injury: a 15-year experience.

BACKGROUND: Traumatic diaphragmatic injury (TDI) is usually associated with multiple injuries. We aimed to evaluate the patterns, associated injuries, and predictors of in-hospital mortality of patients with TDI.

METHODS: The trauma registry from a Primary Adult Resource Center for Trauma was queried for patients admitted with a TDI from January 1995 to December 2009. Patient characteristics, mechanism of injury, associated injuries, management, and outcomes were analyzed. We compared morbidity and mortality in left and right diaphragmatic injuries (LDI and RDI, respectively).

RESULTS: Of the 773 patients, 650 were male (84%), with a mean (SD) age of 33 (15). Mechanism of injury was penetrating in 561 (73%) and blunt in 212 (27%) patients. LDI, RDI, and bilateral injuries were 57%, 40%, and 3%, respectively. The majority of cases were managed by exploratory laparotomy and direct suture repair. LDI was associated with higher rates of splenic, gastric, and pancreatic injuries and prolonged hospital stay in comparison with RDI. In comparison with LDI, RDI was associated with higher rates of deaths (26% vs. 17%, p = 0.003). Overall, mortality in TDI was 21%. Age (odds ratio [OR], 1.02, p = 0.008), Injury Severity Score (ISS) (OR, 1.09, p = 0.001), associated cardiac injury (OR, 2.8, p = 0.005), left diaphragmatic injury (OR, 0.53, p = 0.005), and operative interventions (OR, 0.32, p = 0.001) were independent predictors for mortality.

CONCLUSION: This largest single institution study on TDI in the literature confirms that LDI are more commonly diagnosed than RDI. Exploratory laparotomy is the most common procedure performed for these injuries. Young age and operative interventions are associated with favorable outcome, whereas high ISS, RDI, and associated cardiac injury are independent predictors for mortality.

LEVEL OF EVIDENCE: Epidemiological study, level III.