Section of Trauma Surgery, Department of Surgery, Hamad General Hospital, PO Box 3050, Doha, Qatar.
J Trauma Acute Care Surg. 2013 Jun;74(6):1392-8; quiz 1611. doi: 10.1097/TA.0b013e31828c318e.
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.
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).
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.
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.
Epidemiological study, level III.
创伤性横膈膜损伤（TDI）通常与多处损伤有关。我们旨在评估 TDI 患者的住院死亡率的模式、相关损伤和预测因素。
从一家成人创伤资源中心的创伤登记处查询了 1995 年 1 月至 2009 年 12 月期间因 TDI 入院的患者。分析了患者特征、损伤机制、相关损伤、治疗和结局。我们比较了左和右横膈膜损伤（LDI 和 RDI）的发病率和死亡率。
在 773 名患者中，650 名男性（84%），平均年龄（标准差）为 33（15）岁。损伤机制为穿透性 561 例（73%）和钝性 212 例（27%）。LDI、RDI 和双侧损伤分别为 57%、40%和 3%。大多数病例采用剖腹探查和直接缝合修复治疗。与 RDI 相比，LDI 与更高的脾、胃和胰腺损伤发生率和更长的住院时间相关。与 LDI 相比，RDI 与更高的死亡率相关（26%比 17%，p=0.003）。总的来说，TDI 的死亡率为 21%。年龄（比值比[OR]，1.02，p=0.008）、损伤严重程度评分（ISS）（OR，1.09，p=0.001）、相关心脏损伤（OR，2.8，p=0.005）、左横膈膜损伤（OR，0.53，p=0.005）和手术干预（OR，0.32，p=0.001）是死亡率的独立预测因素。
这是文献中关于 TDI 的最大单机构研究，证实 LDI 比 RDI 更常见。剖腹探查是最常见的治疗这些损伤的方法。年轻和手术干预与良好的结局相关，而高 ISS、RDI 和相关心脏损伤是死亡率的独立预测因素。
流行病学研究，三级。
