title: Diagnosis of blunt traumatic ruptured diaphragm: is it still a difficult problem?
abstract: BACKGROUND
  Blunt traumatic rupture of the diaphragm (BTRD) is uncommon. The diagnosis can be easily overlooked, and radiological findings misinterpreted. In a 15-year experience at the two major trauma hospitals in Brisbane reported in 1991, 85 patients with BTRD were treated, and the diagnosis not always made expeditiously. With the introduction of mandatory Early Management of Severe Trauma course training in the 90s and newer diagnostic tools, it might be expected that BTRD would be a less problematic diagnosis. The aim of this study was to review the incidence, diagnosis and outcome of BTRD at Auckland City Hospital over the last 10 years.
  
  
  METHODS
  Retrospective review of Auckland City hospital trauma registry between 1996 and 2005. Demographics include age, gender, injury severity score (ISS), length of stay, ICU admission days, methods of diagnosis and patient outcomes were reviewed.
  
  
  RESULTS
  Twenty-eight patients had TRD as result of blunt injury. Median ISS was 28.5. Most of the patients were diagnosed at the time of laparotomy for other associated injuries. Road traffic crash was the most common cause. Twenty-one out of 28 patients were discharged alive.
  
  
  CONCLUSIONS
  Diagnosis of BTRD remains difficult. It is rarely isolated. It requires a high index of suspicion. If suspected, chest X-ray (CXR) and other more advanced imaging modalities can be used as confirmatory tools.
authors.affiliation: Trauma Service, Auckland City Hospital, Auckland, New Zealand. lchsee@gmail.com
authors.forename: Li
authors.initials: L
authors.lastname: Hsee
authors.forename: Loretta
authors.initials: L
authors.lastname: Wigg
authors.forename: Ian
authors.initials: I
authors.lastname: Civil
mesh_terms: D003964:Diaphragm / Q000293:injuries*; D005260:Female; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D008297:Male; D012189:Retrospective Studies; D012421:Rupture; D014949:Wounds, Nonpenetrating / Q000175:diagnosis* / Q000453:epidemiology* / Q000601:surgery