Critical Care and Shock

Differences in clinical characteristics according to diaphragmatic injury location: A retrospective observational study

Abstract

Introduction: Although traumatic diaphragmatic ruptures are rare, intra-abdominal organ herniation occurs more commonly in the left diaphragm because the right diaphragm is held by the liver and ligaments underneath. Additionally, right diaphragmatic injuries are sometimes delayed or missed because other comorbidities cover them. This study examined a 10-year experience with traumatic diaphragmatic injuries to better understand the clinical characteristics according to diaphragmatic injury location and improve future treatments.

Methods: This retrospective study enrolled 29 patients with traumatic diaphragmatic rupture admitted to the Chungbuk National University Hospital, South Korea, between January 2011 and December 2020. The patients’ clinical characteristics and treatment outcomes were analyzed using the chi-square test and independent t-test.

Results: The injury severity score showed that left diaphragmatic ruptures (31.36, standard deviation [SD] 10.89) were higher than right-sided ruptures (29.33, SD 10.21), but the difference was not statistically significant (p=0.61). Abdominal organ herniations were more common on the left side, and there were two cases of hollow viscus injuries as left-side ruptures and eight cases of abdominal solid organ injuries as right-side ruptures, but there was no statistical difference between the two groups. There was no significant difference between the two groups in the state of shock during the emergency room visits, intensive care unit, and ventilator care, and no difference was observed in survival.

Conclusion: Depending on the location of the diaphragmatic rupture, there were differences in the number of abdominal organ herniation and surgical methods, but there was no difference in injury severity or outcome.