Blunt traumatic diaphragmatic injury: A diagnostic enigma with potential surgical pitfalls.
BACKGROUND
Blunt traumatic diaphragmatic injury (BTDI) is an uncommon injury and one which is difficult to diagnose. The objective of this study was to identify features associated with this injury.


METHODS
This was a retrospective study based on records of 354307 blunt trauma victims treated between 1998 and 2013 collected by the Israeli National Trauma Registry.


RESULTS
BTDI was reported in 231 (0.065%) patients. Motor vehicle accidents were responsible for 84.4% of the injuries: 97 (42.0%) were reported as drivers; 54 (23.4%) were passengers; 34 (14.7%) were pedestrians hit by cars; and 10 (4.3%) were on motorcycles. There were more males than females (2.5:1) compared with blunt trauma patients without BTDI (p<.001). Patients with BTDI were significantly younger than blunt trauma patients without BTDI (p<.001). ISS was 9-14 in 5.2%, 16-24 in 16.9%, 25-75 in 77.9%. Urgent surgery was performed in 62% of the patients and 79.7% had surgery within 24h of admission. Mortality was 26.8%. Over 40% of patients with BTDI had associated rib, pelvic and/or extremity injuries. Over 30% had associated spleen, liver and/or lung injuries. Nevertheless, less than 1% of patients with skeletal injuries and less than 2.5% with solid organ injuries overall had associated BTDI. Despite hollow viscus injury being less prevalent, up to 6% of patients with this injury had associated BTDI.


CONCLUSIONS
BTDI is infrequent following blunt trauma. Hollow viscus injuries were more predictive of BTDI than skeletal or solid organ injuries.
Division of General Surgery, Hillel Yaffe Medical Center, Hadera, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. Electronic address: mahamidam@yahoo.com.
Ahmad
A
Mahamid
National Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel; Disaster Medicine Department, Faculty of Medicine, Tel-Aviv University, Israel. Electronic address: kobi.peleg@gmail.com.
Kobi
K
Peleg
National Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel. Electronic address: adig@gertner.health.gov.il.
Adi
A
Givon
Division of General Surgery, Hillel Yaffe Medical Center, Hadera, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. Electronic address: alfici@hy.health.gov.il.
Ricardo
R
Alfici
Surgery Department, Shaare Zedek Medical Center, Jerusalem, Israel. Electronic address: oolsha@gmail.com.
Oded
O
Olsha
Division of General Surgery, Hillel Yaffe Medical Center, Hadera, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. Electronic address: i_ashkenazi@yahoo.com.
Itamar
I
Ashkenazi
D000063:Accidents, Traffic / Q000706:statistics & numerical data; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D002648:Child; D003937:Diagnosis, Differential; D003964:Diaphragm / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D012042:Registries; D012189:Retrospective Studies; D017678:Sex Distribution; D014949:Wounds, Nonpenetrating / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000601:surgery; D055815:Young Adult