Traumatic diaphragmatic injury: Experience from a level I trauma center

Jaime D. Lewis, Sandra L. Starnes, Prakash K. Pandalai, Lynn C. Huffman, Christian F. Bulcao, Timothy A. Pritts, Michael F. Reed

Research output: Contribution to journalArticle

23 Scopus citations

Abstract

Objective: Traumatic diaphragmatic injuries (TDI) are uncommon but associated with substantial morbidity and mortality. We sought to analyze patients with TDI at a large trauma center and associated county coroner to identify characteristics predictive of increased mortality. Methods: We queried a level I university trauma center and associated county coroner databases containing >20,000 patients to identify patients with ICD-9 diagnoses pertaining to TDI from January 1992 through May 2005. Once identified, hospital records, operative details, and autopsy reports were reviewed to determine injury characteristics, treatment provided, and outcome. Statistical analyses were performed using the Student t-test, chi-square analysis, analysis of variance, and multiple logistic regression. Results: TDI were identified in 254 individuals. Two hundred (79%) survived to undergo operation. Of the 81 (32%) deaths, 33 (41%) occurred before arrival at the trauma center. Survivors were younger, had lesser injury severity scores (ISS), were more likely to be female, and had more bilateral injuries (P ≤ .002 all) than nonsurvivors. By multiple logistic regression analyses, increased age (odds ratio [OR], 1.044; 95% confidence interval [CI], 1.015-1.074; P = .0029) and greater ISS (OR, 1.145; 95% CI, 1.103-1.188; P < .0001) were predictors of the probability of death in all patients. Conclusion: Although TDI may indicate substantive trauma burden in any patient, those with greater ISS and advanced age are at the greatest risk of death.

Original languageEnglish (US)
Pages (from-to)578-584
Number of pages7
JournalSurgery
Volume146
Issue number4
DOIs
StatePublished - Oct 1 2009

ASJC Scopus subject areas

  • Surgery

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    Lewis, J. D., Starnes, S. L., Pandalai, P. K., Huffman, L. C., Bulcao, C. F., Pritts, T. A., & Reed, M. F. (2009). Traumatic diaphragmatic injury: Experience from a level I trauma center. Surgery, 146(4), 578-584. https://doi.org/10.1016/j.surg.2009.06.040