Impact of deferred treatment of blunt diaphragmatic rupture: a 15-year experience in six trauma centers in Quebec.
BACKGROUND
The purpose of this study was to show that blunt diaphragmatic rupture does not require immediate emergency operation in the absence of other indications.


METHODS
We reviewed all patients with blunt diaphragmatic rupture admitted within 24 hours of injury to one of six university trauma centers providing trauma care for the province of Quebec from April 1, 1984, to March 31, 1999. Multivariate analysis of demographic profiles, severity indices, indications for operation, and preoperative delays was performed.


RESULTS
There were 160 patients (91 men and 69 women) with blunt diaphragmatic rupture. Mean age was 40.1 +/- 16.2 years. Mean Injury Severity Score was 26.9 +/- 11.5 and mortality was 14.4%. Patients undergoing emergency surgery for indications other than diaphragmatic rupture had a significantly higher Injury Severity Score than those undergoing surgery for repair of diaphragmatic rupture alone (34.7 +/- 10.7 vs. 22.0 +/- 9.0, p < 0.001). In patients undergoing surgery for diaphragmatic rupture alone, delay before repair of the diaphragmatic hernia did not lead to an increased mortality compared with patients undergoing immediate surgery (3.4% vs. 5.0%, p = NS).


CONCLUSIONS
Blunt diaphragmatic rupture in the absence of other surgical injuries carries low mortality. Operative repair of diaphragmatic rupture can be deferred without appreciable increased mortality if no other indication mandates immediate surgery.
Bergeron
Eric
E
Choc-trauma Montérégie, Université de Sherbrooke, Sherbrooke, Canada. eric.bergeron@traumaquebec.org
Clas
David
D
Ratte
Sebastien
S
Beauchamp
Gilles
G
Denis
Ronald
R
Evans
David
D
Frechette
Pierre
P
Martin
Marcel
M
D000328:Adult; D002423:Cause of Death; D003964:Diaphragm / Q000293:injuries*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000401:mortality / Q000601:surgery; D015999:Multivariate Analysis; D011792:Quebec / Q000453:epidemiology; D012189:Retrospective Studies; D012421:Rupture / Q000401:mortality / Q000601:surgery; D016019:Survival Analysis; D013997:Time Factors; D015599:Trauma Severity Indices; D014949:Wounds, Nonpenetrating / Q000401:mortality / Q000601:surgery*