Blunt traumatic diaphragmatic injury: A diagnostic enigma with potential surgical pitfalls

BackgroundBlunt 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.MethodsThis was a retrospective study based on records of 354 307 blunt trauma victims treated between 1998 and 2013 collected by the Israeli National Trauma Registry.ResultsBTDI 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 24 h 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.ConclusionsBTDI is infrequent following blunt trauma. Hollow viscus injuries were more predictive of BTDI than skeletal or solid organ injuries.