Division of Trauma and Acute Care Surgery, Department of Surgery, Department of Intensive Care, Fundación Valle del Lili, Cra 98 No. 18-49, 760032, Cali, Colombia.
Division of Trauma and Acute Care Surgery, Department of Surgery, Universidad del Valle, Cali, Colombia.
World J Emerg Surg. 2022 Sep 13;17(1):47. doi: 10.1186/s13017-022-00453-9.
Penetrating diaphragmatic injuries are associated with a high incidence of posttraumatic empyema. We analyzed the contribution of trauma severity, specific organ injury, contamination severity, and surgical management to the risk of posttraumatic empyema in patients who underwent surgical repair of diaphragmatic injuries at a level 1 trauma center.
This is a retrospective review of the patients who survived more than 48 h. Univariate OR calculations were performed to identify potential risk factors. Multiple logistic regression was used to calculate adjusted ORs and identify independent risk factors.
We included 192 patients treated from 2011 to 2020. There were 169 (88.0) males. The mean interquartile range, (IQR) of age, was 27 (22-35) years. Gunshot injuries occurred in 155 subjects (80.7%). Mean (IQR) NISS and ATI were 29 (18-44) and 17 (10-27), respectively. Thoracic AIS was > 3 in 38 patients (19.8%). Hollow viscus was injured in 105 cases (54.7%): stomach in 65 (33.9%), colon in 52 (27.1%), small bowel in 42 (21.9%), and duodenum in 10 (5.2%). Visible contamination was found in 76 patients (39.6%). Potential thoracic contamination was managed with a chest tube in 128 cases (66.7%), with transdiaphragmatic pleural lavage in 42 (21.9%), and with video-assisted thoracoscopy surgery or thoracotomy in 22 (11.5%). Empyema occurred in 11 patients (5.7%). Multiple logistic regression identified thoracic AIS > 3 (OR 6.4, 95% CI 1.77-23. 43), and visible contamination (OR 5.13, 95% IC 1.26-20.90) as independent risk factors. The individual organ injured, or the method used to manage the thoracic contamination did not affect the risk of posttraumatic empyema.
The severity of the thoracic injury and the presence of visible abdominal contamination were identified as independent risk factors for empyema after penetrating diaphragmatic trauma.
穿透性膈肌损伤与创伤后脓胸的发生率较高有关。我们分析了创伤严重程度、特定器官损伤、污染严重程度和手术治疗对在 1 级创伤中心接受膈肌损伤手术修复的患者发生创伤后脓胸的风险的影响。
这是一项对幸存者超过 48 小时的患者进行的回顾性研究。使用单变量 OR 计算来确定潜在的危险因素。使用多因素逻辑回归计算调整后的 OR 并确定独立的危险因素。
我们纳入了 2011 年至 2020 年期间治疗的 192 名患者。其中 169 名（88.0%）为男性。年龄的中位数（IQR）为 27（22-35）岁。155 名患者（80.7%）遭受枪击伤。NISS 和 ATI 的平均值（IQR）分别为 29（18-44）和 17（10-27）。38 名患者（19.8%）的胸部 AIS>3。105 例（54.7%）存在空腔脏器损伤：胃 65 例（33.9%），结肠 52 例（27.1%），小肠 42 例（21.9%），十二指肠 10 例（5.2%）。76 名患者（39.6%）存在可见污染。128 例（66.7%）采用胸腔引流管处理潜在的胸腔污染，42 例（21.9%）采用经膈胸膜灌洗，22 例（11.5%）采用胸腔镜手术或开胸手术。11 名患者（5.7%）发生脓胸。多因素逻辑回归分析确定胸部 AIS>3（OR 6.4，95%CI 1.77-23.43）和可见污染（OR 5.13，95%IC 1.26-20.90）为独立危险因素。受伤的单个器官或用于处理胸腔污染的方法并不影响穿透性膈肌创伤后脓胸的风险。
胸部损伤的严重程度和可见的腹部污染是穿透性膈肌创伤后发生脓胸的独立危险因素。
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