A Case Series Focusing on Blunt Traumatic Diaphragm Injury at a Level 1 Trauma Center.

Introduction

Detection of blunt traumatic diaphragm injury (TDI) can be challenging in the absence of surgical exploration. Our objective is to study the mechanisms of injury and detection modes for patients with blunt TDI.

Methods

This is a single-center, retrospective review conducted in a level 1 trauma center from 2016 to 2023, inclusive. We identified seven patients with blunt TDI using the primary mechanisms and trauma type.

Results

Out of seven patients, two were associated with motor vehicle collisions, four were pedestrians struck, and one fell down the stairs. The mean ISS was 48.4 (29-75). Of the seven patients with blunt TDI, four died in the trauma bay-two from traumatic arrest and two died spontaneously. Multiple rib fractures were one of the common injury patterns in six cases, whereas in the remaining case, blunt TDI was confirmed at laparotomy and repaired. One patient died two days after admission. Of the two patients who survived, one had a TDI identified during video-assisted thoracic surgery (VATS) for retained hemothorax, and one patient had a TDI repaired during emergent exploratory laparotomy for other injuries. In the remaining four patients, blunt TDI was confirmed based on their autopsy reports.

Conclusions

Injuries in all seven cases were sustained with a high-energy injury mechanism. Multiple rib fractures were reported in six cases. Based on our findings, we recommend that clinicians maintain a high level of suspicion for blunt TDI in patients with thoracoabdominal trauma, especially in cases with rib fractures or high-impact trauma.