Ann Surg Treat Res.  2019 Jul;97(1):36-40. 10.4174/astr.2019.97.1.36.

Diagnostic significance of diaphragmatic height index in traumatic diaphragmatic rupture

• Kwon J
• Lee JC
• Moon J

• KMID: 2450988
• DOI: http://doi.org/10.4174/astr.2019.97.1.36

Abstract

PURPOSE
Traumatic diaphragmatic rupture resulting from blunt trauma is usually severe. However, it is often overlooked during initial evaluation because there are no characteristic signs and symptoms. Thus, this study aimed to determine the clinical characteristics of diaphragmatic rupture caused by blunt trauma and investigate the diagnostic usefulness of diaphragmatic height index (DHI) measured using chest radiographs.
METHODS
The cohort comprised patients who were admitted due to diaphragmatic rupture from blunt trauma. Patients were divided into 2 groups; the control group comprised patients with blunt trauma who were matched for age, sex, and Injury Severity Score, while the DHI group comprised patients with diaphragmatic rupture from blunt trauma. Receiver operating characteristic curve was used to determine the cutoff value of DHI for diaphragmatic injury. The sensitivity, specificity, predictability, accuracy, and likelihood ratio of the cutoff were then determined.
RESULTS
A total of 60 patients were confirmed to have diaphragmatic rupture. The mean DHI in patients with diaphragmatic rupture on the right and left side were both significantly different compared to that in the control group. A DHI cutoff value of >1.31 showed 71% sensitivity and 87% specificity for diagnosing right diaphragmatic rupture, while a cutoff value of <0.43 showed 87% sensitivity and 76% specificity for diagnosing left diaphragmatic rupture.
CONCLUSION
DHI can be useful in the diagnosis of diaphragmatic rupture. DHI as determined using chest radiographs in patients with blunt abdominal trauma, particularly in those ineligible for diagnostic work-up, may help in the diagnosis of diaphragmatic rupture.

Keyword

Diaphragm; Abdominal injuries; Multiple trauma

MeSH Terms

Abdominal Injuries
Cohort Studies
Diagnosis
Diaphragm
Humans
Injury Severity Score
Multiple Trauma
Radiography, Thoracic
ROC Curve
Rupture*
Sensitivity and Specificity

Figure

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  Fig. 1 Anteroposterior chest radiographs used for calculating the diaphragmatic height index. DHD, diaphragmatic height difference; VH, vertebrae height.

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  Fig. 2 Flow chart of patient selection in the study. EMR, electronic medical record; ISS, injury severity score; Group R, right side of the diaphragm; Group L, left side of the diaphragm; Group C, control group.

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