title: Traumatic diaphragmatic injuries: a retrospective review of a 12-year experience at a tertiary trauma centre.
abstract: BACKGROUND
  Traumatic diaphragmatic injuries (TDIs) are clinically challenging. We aimed to review TDIs treated at a tertiary trauma centre over a 12-year period.
  
  
  METHODS
  This was a single-centre retrospective review of adult patients with TDIs treated between 1 January 2003 and 31 December 2014. Primary outcomes were mortality rates and Injury Severity Scores (ISS) associated with each TDI subtype. Secondary outcomes included proportions of TDIs diagnosed radiologically, operatively or during autopsy. We compared the TDI subtypes with respect to mechanism of injury, mortality rates and median ISS. Data was analysed using descriptive statistics.
  
  
  RESULTS
  Among 46 patients studied, the TDI subtypes noted were acute diaphragmatic herniation (n = 14, 30.4%), tears (n = 22, 47.8%) and contusions (n = 10, 21.7%). Patients with these TDI subtypes had a mortality rate of 35.7%-100%, while the ISS ranges for survivors and deaths were 22.0-34.0 (interquartile range [IQR] 6.5-23.0) and 53.5-66.0 (IQR 16.0-28.5), respectively. TDIs were identified via chest radiography (n = 2/33, 6.1%) and computed tomography (n = 6/13, 46.2%). All survivors (n = 21) and deaths (n = 25) underwent open surgery or autopsy, respectively, which confirmed TDIs. Blunt traumas and penetrating traumas were more frequently associated with acute herniation/contusions and tears, respectively. There were statistically significant differences among the TDI subtypes in their mechanism of injury, mortality rate and median ISS of survivors.
  
  
  CONCLUSIONS
  TDIs showed varying injury patterns with blunt versus penetrating mechanisms of injury, and were associated with significant mortality rates. Preoperative imaging had limited diagnostic use.
authors.affiliation: Emergency Department, Ng Teng Fong General Hospital, Singapore.
authors.forename: Beng Leong
authors.initials: BL
authors.lastname: Lim
authors.affiliation: Department of General Surgery, Tan Tock Seng Hospital, Singapore.
authors.forename: Li Tserng
authors.initials: LT
authors.lastname: Teo
authors.affiliation: Department of General Surgery, Tan Tock Seng Hospital, Singapore.
authors.forename: Ming Terk
authors.initials: MT
authors.lastname: Chiu
authors.affiliation: Emergency Department, Ng Teng Fong General Hospital, Singapore.
authors.forename: Marxengel L
authors.initials: ML
authors.lastname: Asinas-Tan
authors.affiliation: Emergency Department, Tan Tock Seng Hospital, Singapore.
authors.forename: Eillyne
authors.initials: E
authors.lastname: Seow
mesh_terms: D000293:Adolescent; D000328:Adult; D003964:Diaphragm / Q000293:injuries*; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D013902:Radiography, Thoracic; D012042:Registries; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging*; D014950:Wounds, Penetrating / Q000000981:diagnostic imaging*; D055815:Young Adult
keywords: mortality; traumatic diaphragmatic injuries