ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
Evaluation of the patients diagnosed with diaphragmatic rupture in emergency room
Ferhat İçme1, Erkan Balkan2, Sinan Becel1, Havva Şahin Kavaklı1, Yücel Yüzbaşıoğlu1, Alp Şener1
1Department of Emergency Services, Atatürk Training and Research Hospital, Ankara, Turkey
2Department of Thoracic Surgery, Atatürk Training and Research Hospital, Ankara, Turkey
DOI : 10.5606/tgkdc.dergisi.2013.7261
Background: This study aims to review the patient characteristics and management of diaphragmatic injuries in patients who were admitted to emergency room due to thoracoabdominal trauma.

Methods: Between April 2005 and December 2011, medical files of 20 patients (18 males, 2 females; mean age 44.4±13.8 years; range 18 to 72 years) who were admitted to Ankara Atatürk Training a nd R esearch H ospital, E mergency D epartment d ue to thoracoabdominal trauma and diagnosed with diaphragmatic injury were retrospectively analyzed. The effects of demographic characteristics of the patients, underlying etiology of the disease, diagnostic evaluation, concomitant injuries, treatment received and trauma scores [the Glascow Coma Score (GCS), Revised Trauma Score (RTS), Injury Severity Score (ISS), Trauma Injury Severity Score (TRISS)] on the length of hospital were evaluated.

Results: Four of the patients had penetrating injuries, while 16 had blunt trauma. The initial examination in the emergency room revealed GCS:13.4±2.8, RTS: 5.8±3.1, ISP: 18.8±7.6 and a predicted death rate of 6.4±10.4 according to TRISS. There was no statistically significant difference in the length of hospital stay based on RTS and GCS, whereas the length of hospital stay was significantly longer in patients with ISS scores ≥16, compared to those with ISS scores <16. The mean length of hospital stay of the patients was 20.4±23.1 days. No mortality was seen in any patient.

Conclusion: In cases of thoracoabdominal trauma in the upper abdomen and/or lower thoracic region, particularly, diaphragmatic injury should be considered and the tests should be assessed carefully. In addition, we believe that anatomical scoring systems (ISS) should be preferred rather than physiologic scoring systems (RTS, GCS) in predicting mortality and the length of hospital stay in patients with certain anatomical disorders, which may be life-threatening alone such as rupture of the diaphragm.

Keywords : Diagnosis; diaphragm; rupture; treatment
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