title: Blunt diaphragmatic rupture--a rare but challenging entity in thoracoabdominal trauma.
abstract: OBJECTIVE
  Delayed diagnosis of blunt traumatic diaphragmatic rupture (BDR) is not uncommon in the emergency department (ED) despite improvement in investigative techniques. We reviewed a large case series of patients diagnosed with blunt traumatic diaphragmatic rupture in order to report demographics, clinical features, and mechanisms of injury of this important but challenging entity.
  
  
  METHODS
  From January 2001 through December 2009, 43 patients were diagnosed with BDR at Linkou Chang Gung Memorial Hospital. Demographic data, including sex, age, initial hemodynamic parameters, laboratory data, diagnostic imaging, trauma mechanism, injury location, associated injuries, injury severity score (ISS), time to diagnosis, intensive care unit length of stay (ICU LOS), hospital length of stay (hospital LOS), and mortality, were extracted from hospital records.
  
  
  RESULTS
  A total of 43 patients (34 men; 9 women) with BDR were analyzed. Their median age was 37 years (15-82 yrs). Most of these injuries were related to traffic collision (76.8%). The anatomic location of injury to the diaphragm consisted of 24 left-sided (55.8%), 14 right-sided (32.6%),and 5 bilateral diaphragmatic injuries. (11.6%) Hemopneumothorax was the most common associated injury (37.2%). The median diagnostic time was 8 hours (range 2 to 366 hrs). The median ISS score was 18 (range 9 to 41). The median ICU LOS was 4 days (range 0 to 99 ds) and the median HLOS was 19 days (range 1 to 106ds). The total mortality rate was 9.3%. Initial high ISS, initial shock and bilateral diaphragmatic injury significantly increased mortality.
  
  
  CONCLUSIONS
  BDR constitutes a rare entity in thoracoabdominal trauma and most of these injuries were related to traffic collision. High index of suspicion was still the main factor to early diagnosis of this case. The mortality was related to initial shock , bilateral BDR and high ISS. Proper initial resuscitation and correction of other serious injuries may be more life-saving in patients with BDR.
authors.affiliation: Departments of Traumatology and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Kwei-Shan Shiang, Taoyuang 33300, Taiwan.
authors.forename: I-Ming
authors.initials: IM
authors.lastname: Kuo
authors.forename: Chien-Hung
authors.initials: CH
authors.lastname: Liao
authors.forename: Ming-Che
authors.initials: MC
authors.lastname: Hsin
authors.forename: Shih-Ching
authors.initials: SC
authors.lastname: Kang
authors.forename: Shang-Yu
authors.initials: SY
authors.lastname: Wang
authors.forename: Chun-Hsiang
authors.initials: CH
authors.lastname: Ooyang
authors.forename: Jen-Feng
authors.initials: JF
authors.lastname: Fang
mesh_terms: D000007:Abdominal Injuries / Q000175:diagnosis* / Q000209:etiology; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003964:Diaphragm / Q000293:injuries*; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012421:Rupture; D013898:Thoracic Injuries / Q000175:diagnosis* / Q000209:etiology; D014949:Wounds, Nonpenetrating / Q000175:diagnosis* / Q000209:etiology; D055815:Young Adult