North Pacific Surgical AssociationTraumatic diaphragmatic injury in the American College of Surgeons National Trauma Data Bank: a new examination of a rare diagnosis
Section snippets
Methods
To perform this study, we used the American College of Surgeons NTDB. The NTDB is the largest available source of trauma registry data in the United States.15, 16, 17 We used the dataset collected and compiled in 2012, as this is both the largest and most recent dataset available currently. It contains 833,309 individual patient records that have been subjected to a quality screening for consistency and validity.
TDIs were identified by International Classification of Diseases 9th Revision
Results
There were 833,309 individual patient records available in the 2012 NTDB. Of this cohort, 3,783 patients were diagnosed with TDI, as defined by International Classification of Diseases 9th Revision codes. Of these 3,783 patients, 2,543 patients (67%) were diagnosed with a penetrating TDI, while 1,240 patients (33%) were diagnosed with a blunt TDI. Patient who were diagnosed with blunt TDI were older, less likely to be male, and had a higher overall injury severity score (Table 1).
Of the
Comments
Previous authors have established that rupture of the diaphragm because of blunt trauma represents the presence of a significant crush or deceleration force dissipated across the abdominopelvic cavity and blunt TDI has been associated with a higher mortality rate than penetrating TDI.5, 9 Our results confirm these findings, as patients in our cohort with a blunt TDI had both a higher mortality rate and a higher ISS, reflecting their severe associated injuries. Furthermore, the relationship
Conclusions
Diaphragmatic injury is a rare but significant entity in trauma patients. The NTDB provides the largest single series of patients described with this entity to date, allowing for analysis of patterns of injury on a larger scale and among multiple trauma centers. Clinicians should be beware of TDI in bluntly injured patients with specific injury patterns, specifically injuries to the thoracic aorta, lung, spleen, and bladder, and consider additional diagnostic workup or clinical intervention in
Acknowledgments
The authors would like to thank the staff of the Trauma Research Institute of Oregon.
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The authors have recieved no grants, honoraria, consultancies, speakers' bureau, advisory-board positions, or significant stock holdings related to this work.
Disclaimer: Committee on Trauma, American College of Surgeons, NTDB NSP 2012, Chicago, IL. The content reproduced from the NTDB NSP remains the full and exclusive copyrighted property of the American College of Surgeons. The American College of Surgeons is not responsible for any claims arising from works based on the original data, text, tables, or figures.