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

21 Citations (Scopus)

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 2009

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Trauma Centers
Wounds and Injuries
Injury Severity Score
Coroners and Medical Examiners
Logistic Models
Odds Ratio
Confidence Intervals
Mortality
Hospital Records
International Classification of Diseases
Chi-Square Distribution
Survivors
Autopsy
Analysis of Variance
Regression Analysis
Databases
Students
Morbidity

ASJC Scopus subject areas

  • Surgery

Cite this

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

Traumatic diaphragmatic injury : Experience from a level I trauma center. / Lewis, Jaime D.; Starnes, Sandra L.; Pandalai, Prakash K.; Huffman, Lynn C.; Bulcao, Christian F.; Pritts, Timothy A.; Reed, Michael F.

In: Surgery, Vol. 146, No. 4, 10.2009, p. 578-584.

Research output: Contribution to journalArticle

Lewis, JD, Starnes, SL, Pandalai, PK, Huffman, LC, Bulcao, CF, Pritts, TA & Reed, MF 2009, 'Traumatic diaphragmatic injury: Experience from a level I trauma center', Surgery, vol. 146, no. 4, pp. 578-584. https://doi.org/10.1016/j.surg.2009.06.040
Lewis JD, Starnes SL, Pandalai PK, Huffman LC, Bulcao CF, Pritts TA et al. Traumatic diaphragmatic injury: Experience from a level I trauma center. Surgery. 2009 Oct;146(4):578-584. https://doi.org/10.1016/j.surg.2009.06.040
Lewis, Jaime D. ; Starnes, Sandra L. ; Pandalai, Prakash K. ; Huffman, Lynn C. ; Bulcao, Christian F. ; Pritts, Timothy A. ; Reed, Michael F. / Traumatic diaphragmatic injury : Experience from a level I trauma center. In: Surgery. 2009 ; Vol. 146, No. 4. pp. 578-584.
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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.",
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AB - 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.

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