Predictive Factors for Evaluation Diaphragm Injuries Following Left-sided Thoraco-abdominal Penetrating Wounds in Maharat Nakhon Ratchasima Hospital

Abstract

Background: Diaphragmatic injuries occur in 3% to 5% of patients with penetrating chest traumas. Diagnosing diaphragmatic injuries is difficult based on physical examination and investigation unless obvious signs and symptoms are present. Diagnostic Laparoscopy (DL) is an efficient technique to diagnose and treat diaphragm injuries at the early stage among hemodynamically stable patients. Routine laparotomy for every penetrating thoracoabdominal wound increases the negative laparotomy rate (5% - 40%), leading to more complications, longer hospital stays, and increased costs. Although DL diminishes the negative laparotomy rate, there are some complications. However, laparoscopic intervention is needed to prevent morbidity from unnecessary operations and negative operative findings.

Objectives: The purpose of this study was to determine the predictive factors to evaluate the left diaphragm injuries undergone by Diagnostic Laparoscopy at Maharat Nakhon Ratchasima Hospital (MNRH) and to discuss the outcomes of the findings between patients with diaphragm injuries and patients without diaphragm injuries

Materials and Methods: This Prospective study was conducted among the patients with left-sided thoracoabdominal penetrating wounds admitted to the MNRH from January 1, 2021, to January 31, 2023. The primary outcome of the study was predictive factors of diaphragmatic injuries. The secondary outcome was the length of stays. Stata/SE v11.1 would analyze all data. Chi-square was used to describe predictive factors between the two groups. P value less than 0.05 would be considered the statistical significance.

Results: The total of 52 patients were included. Six individuals (11.53%) had diaphragm injuries. The locations of the injuries below ICS 7^th had significant predictive factors of diaphragm injuries, with the odds ratio of 8.73 (95% CI 1.02, 74.95) p = 0.048. The length of stay of the two groups had no significant differences between 5.51 ± 11.19 days in normal and 12.93 ± 26.91 days in diaphragm injuries (95% CI 0.98, 1.05), p = 0.519. There were no significant predictive factors of gender, age, mechanism, CXR, FAST, and multiple sites of injuries.

Conclusion: The locations of injuries below ICS 7th had significant predictive factors of diaphragm injuries. The study limitations were the small population size and the high percentage of unfavorable intraabdominal results. The length of stay of the two groups had no significant differences, similar to other factors.