Table 1 Characteristics of patients with traumatic diaphragm injury eligible for analysis and their comparisons based on penetrating and blunt injury mechanisms
Variables | overall n = 771 | Penetrating n = 230 (29.8%) | Blunt n = 541 (70.2%) | p value |
|---|---|---|---|---|
Age, years | 56 [39–70] | 49 [36–64] | 59 [41–72] |  < 0.001 |
Male sex | 515 (66.8%) | 158 (68.7%) | 357 (66.0%) | 0.50 |
Cause of trauma | ||||
 Accident | 482 (62.5%) | 19 (8.3%) | 463 (85.6%) |  < 0.001 |
 Self-injury, suicide | 138 (17.9%) | 112 (48.7%) | 26 (4.8%) |  < 0.001 |
 Assault | 91 (11.8%) | 89 (38.7%) | 2 (0.4%) |  < 0.001 |
 Work-related | 45 (5.8%) | 5 (2.2%) | 40 (7.4%) | 0.003 |
TDI classification | ||||
 Contusion (OIS I) | 53 (6.9%) | 13 (5.7%) | 40 (7.4%) | 0.43 |
 Laceration (OIS II-IV) | 370 (48.0%) | 193 (83.9%) | 177 (32.7%) |  < 0.001 |
 Rupture with herniation | 348 (45.1%) | 24 (10.4%) | 324 (59.9%) |  < 0.001 |
On-scene cardiac arrest | 6 (0.8%) | 0 (0%) | 6 (1.1%) | 0.18 |
On-scene hypotension* | 101 (13.1%) | 47 (20.4%) | 54 (10.0%) |  < 0.001 |
On-scene Shock Index ≥ 1** | 174 (22.6%) | 63 (27.4%) | 111 (20.5%) | 0.038 |
Hypotension on hospital arrival* | 206 (26.7%) | 66 (28.7%) | 140 (25.9%) | 0.42 |
Shock Index ≥ 1 on hospital arrival** | 292 (37.9%) | 83 (36.1%) | 209 (38.6%) | 0.51 |
ISS | 26 [18–38] | 18 [13–25] | 32 [22–42] |  < 0.001 |
RTS | 7.6 [6.0–7.8] | 7.6 [6.6–7.8] | 7.1 [5.7–7.8] |  < 0.001 |
TRISS Ps, % | 88 [55–96] | 95 [89–97] | 80 [42–93] |  < 0.001 |
Isolated TDI | 19 (2.5%) | 6 (2.6%) | 13 (2.4%) | 0.80 |
Body region of severe†concomitant injury | ||||
 Head | 159 (20.6%) | 3 (1.3%) | 156 (28.8%) |  < 0.001 |
 Abdomen | 324 (42.0%) | 116 (50.4%) | 208 (38.5%) | 0.002 |
 Vertebra | 36 (4.7%) | 2 (0.9%) | 34 (6.3%) |  < 0.001 |
 Upper extremity | 41 (5.3%) | 3 (1.3%) | 38 (7.0%) |  < 0.001 |
 Lower extremity including pelvis | 185 (24.0%) | 1 (0.4%) | 184 (34.0%) |  < 0.001 |
Any concomitant abdominal injury | 525 (68.1%) | 179 (77.8%) | 346 (64.0%) |  < 0.001 |
Associated injury | ||||
 Hemothorax or pneumothorax | 321 (41.6%) | 78 (33.9%) | 243 (44.9%) | 0.005 |
 Tension pneumothorax | 16 (2.1%) | 4 (1.7%) | 12 (2.2%) | 0.78 |
 Massive hemothorax | 21 (2.7%) | 11 (4.8%) | 10 (1.9%) | 0.029 |
 Flail chest | 36 (4.7%) | 0 (0%) | 36 (6.7%) |  < 0.001 |
 Thoracic aorta | 40 (5.2%) | 1 (0.4%) | 39 (7.2%) |  < 0.001 |
 Heart | 28 (3.6%) | 15 (6.5%) | 13 (2.4%) | 0.009 |
 Lung | 284 (36.8%) | 64 (27.8%) | 220 (40.7%) |  < 0.001 |
 Trachea/main stem bronchus | 3 (0.4%) | 2 (0.9%) | 1 (0.2%) | 0.21 |
 Rib | 358 (46.4%) | 31 (13.5%) | 327 (60.4%) |  < 0.001 |
 Sternum | 18 (2.3%) | 2 (0.9%) | 16 (3.0%) | 0.11 |
 Esophagus | 2 (0.3%) | 2 (0.9%) | 0 (0%) | 0.088 |
 Colon | 55 (7.1%) | 16 (7.0%) | 39 (7.2%) | 1.00 |
 Intestine | 59 (7.7%) | 17 (7.4%) | 42 (7.8%) | 1.00 |
 Kidney | 74 (9.6%) | 10 (4.4%) | 64 (11.8%) |  < 0.001 |
 Liver | 248 (32.2%) | 93 (40.4%) | 155 (28.7%) | 0.001 |
 Mesentery | 84 (10.9%) | 14 (6.1%) | 70 (12.9%) | 0.005 |
 Pancreas | 30 (3.9%) | 8 (3.5%) | 22 (4.1%) | 0.83 |
 Spleen | 155 (20.1%) | 25 (10.9%) | 130 (24.0%) |  < 0.001 |
 Stomach | 66 (8.6%) | 42 (18.3%) | 24 (4.4%) |  < 0.001 |
 Duodenum | 8 (1.0%) | 2 (0.9%) | 6 (1.1%) | 1.00 |
CT of chest/abdomen | 656 (85.1%) | 187 (81.3%) | 469 (86.7%) | 0.060 |
Initial therapeutic management | ||||
 Thoracotomy/laparotomy | 549 (71.2%) | 187 (81.3%) | 362 (66.9%) |  < 0.001 |
 Thoracotomy alone | 99 (12.8%) | 36 (15.7%) | 63 (11.7%) | 0.12 |
 Laparotomy alone | 314 (40.7%) | 86 (37.4%) | 228 (42.1%) | 0.23 |
 Endoscopic surgery alone | 30 (3.9%) | 9 (3.9%) | 21 (3.9%) | 1.00 |
 Non-operative management | 192 (24.9%) | 34 (14.8%) | 158 (29.2%) |  < 0.001 |
Diaphragm repair | 392 (50.8%) | 133 (57.8%) | 259 (47.9%) | 0.011 |
Blood transfusion within 24Â h | 535 (69.4%) | 156 (67.8%) | 379 (70.1%) | 0.60 |
Mortality | 162 (21.0%) | 19 (8.3%) | 143 (26.4%) |  < 0.001 |