Indications for using video-assisted thoracoscopic surgery to diagnose diaphragmatic injuries after penetrating chest trauma.
BACKGROUND
Video-assisted thoracoscopic surgery (VATS) has been shown to be an accurate method for identifying diaphragmatic injuries (DIs). The purpose of this investigation was to establish specific indications for the use of VATS after penetrating chest trauma.


METHODS
A retrospective review of all patients undergoing VATS after penetrating chest trauma at a level 1 trauma center over an 8-year period was performed. Logistic regression was used in an attempt to identify independent predictors of DI.


RESULTS
One hundred seventy-one patients underwent VATS assessment of a hemidiaphragm, and 60 patients (35%) were found to have a DI. Five independent risk factors for DI were identified from analyzing the patient records: abnormal chest radiograph, associated intraabdominal injuries, high-velocity mechanism of injury, entrance wound inferior to the nipple line or scapula, and right-sided entrance wound.


CONCLUSIONS
In the largest published series of patients undergoing VATS to exclude a DI, this review identifies five independent predictors of DI after penetrating chest trauma. A diagnostic algorithm incorporating these five factors was designed with the goal of reducing the number of unrecognized DIs after penetrating chest trauma by using VATS for patients at greatest risk for such injuries.
Freeman
R K
RK
Department of Cardiovascular and Thoracic Surgery, The University of Texas Southwestern Medical Center, Dallas 75390, USA.
Al-Dossari
G
G
Hutcheson
K A
KA
Huber
L
L
Jessen
M E
ME
Meyer
D M
DM
Wait
M A
MA
DiMaio
J M
JM
D000328:Adult; D003964:Diaphragm / Q000293:injuries* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D013898:Thoracic Injuries / Q000175:diagnosis* / Q000601:surgery; D020775:Thoracic Surgery, Video-Assisted; D014948:Wounds, Gunshot / Q000175:diagnosis / Q000601:surgery; D014950:Wounds, Penetrating / Q000175:diagnosis* / Q000601:surgery; D014951:Wounds, Stab / Q000175:diagnosis / Q000601:surgery