Original article: general thoracic
Indications for using video-assisted thoracoscopic surgery to diagnose diaphragmatic injuries after penetrating chest trauma

Presented at the Forty-seventh Annual Meeting of the Southern Thoracic Surgical Association, Marco Island, FL, Nov 9–11, 2000.
https://doi.org/10.1016/S0003-4975(01)02803-XGet rights and content

Abstract

Background. Video-assisted thoracoscopic surgery (VATS) has been shown to be an accurate method for identifying diaphragmatic injuries (DIs). The purpose of this investigation was to establish specific indications for the use of VATS after penetrating chest trauma.

Methods. A retrospective review of all patients undergoing VATS after penetrating chest trauma at a level 1 trauma center over an 8-year period was performed. Logistic regression was used in an attempt to identify independent predictors of DI.

Results. One hundred seventy-one patients underwent VATS assessment of a hemidiaphragm, and 60 patients (35%) were found to have a DI. Five independent risk factors for DI were identified from analyzing the patient records: abnormal chest radiograph, associated intraabdominal injuries, high-velocity mechanism of injury, entrance wound inferior to the nipple line or scapula, and right-sided entrance wound.

Conclusions. In the largest published series of patients undergoing VATS to exclude a DI, this review identifies five independent predictors of DI after penetrating chest trauma. A diagnostic algorithm incorporating these five factors was designed with the goal of reducing the number of unrecognized DIs after penetrating chest trauma by using VATS for patients at greatest risk for such injuries.

Section snippets

Material and methods

A retrospective review of all patients undergoing VATS after penetrating chest trauma seen at Parkland Memorial Hospital between January 1992 and December 1999 was performed. During this 8-year period, patients who were thought to be at risk for DI after penetrating chest trauma without a separate indication for celiotomy or thoracotomy underwent VATS on the basis of criteria in a previous publication [9]. Only patients in hemodynamically stable condition with an isolated, unilateral

Results

During the study period, 171 patients who met the inclusion criteria were referred for VATS to exclude a DI after penetrating chest trauma. Sixty patients (35%) were found to have a DI by VATS (DI group). During the same period, 42 DIs were recognized in the study institution in patients who did not require VATS. The characteristics of the DI group were compared with those of the 111 patients (65%) who did not have a DI (no-DI group) (Table 1). Mean age and sex were comparable between the two

Comment

Diaphragm is derived from the Greek words dia, meaning in between, and phragma, meaning fence. First described by Sennertus, DIs resulting from penetrating chest trauma are not uncommon [11]. Previous reviews including one from our institution 1, 2, 3, 4, 5, 6, 7, report a 3% overall incidence of DI after abdominal or chest trauma. These reviews also confirm that the etiologies of DI are penetrating or blunt injury mechanisms in a 2:1 ratio, respectively. Injuries to the diaphragm are important

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    Copyright © 2001 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.