AI Summary & Key Takeaways
AI InsightThe overall mortality rate was 21%.
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Abstract
Diaphragmatic injuries are infrequent but severe injuries, associated with high morbidity and mortality. METHODS The hospital records of 58 patients with traumatic rupture of diaphragm which was diagnosed during surgery in emergency department during last five years were re-evaluated, in order to identify the factors on mortality. RESULTS The mean age of patients was 33 years. The most common cause of diaphragmatic rupture was penetrating injury (52%). The overall mortality rate was 21%. Preoperative diagnoses were accurately made in only twelve (20%) patients and remaining 46 patients were diagnosed during surgery. Rupture was located on the left side in 42 patients. Intrathoracic herniation was seen in eleven cases. Presence of herniation has no effect on mortality (p=0.155). All cases with mortal course were blunt trauma and the most common cause of death was haemorrhagic shock. Associated injuries were present in 88% of the patients; 92% of the mortal cases had an associated injury. CONCLUSION The diagnosis of diaphragmatic injury is important due to increased morbidity and mortality in traumatic victims. Blunt trauma, increased grade of injury, presence of shock, blood transfusions over three units and splenic injury are factors influencing mortality in traumatic ruptures of diaphragm.
Özet
Diyafragma rüptürleri sık görülmeyen fakat yüksek morbidite ve mortalite ile seyreden ciddi yaralanmalardır. GEREÇ VE YÖNTEM Acil serviste son beş yıl içinde travmatik diyafragma rüptürü saptanan 58 hastanın dosyası mortaliteyi etkileyen faktörleri belirlemek için incelendi. BULGULAR Hastaların ortalama yaşı 33, mortalite oranı %21 ve en sık diyafragmatik rüptür nedeni penetran yaralanmalardı (%52). Sadece 12 hasta (%20) ameliyat öncesi dönemde diyafragma rüptürü tanısı alırken kalan 46 hasta ise cerrahi sırasında tanı aldı. Kırk iki hastada sol diyafragma rüptürü saptandı. İntratorasik herniasyon 11 hastada saptandı. Herniasyon varlığı mortaliteyi etkilemedi (p=O,155). Mortalite ile seyreden tüm hastalarda kunt travma vardı ve en yaygın ölüm nedeni hemorajik şok idi. Hastaların %88'inde eşlik eden yaralanmalar vardı ve mortal seyreden hastaların %92'sinde eşlik eden yaralanma mevcut idi. SONUÇ Travmalı hastada diyafragma yaralanmasının tanısı yüksek morbidite ve mortalite nedeni ile önemlidir. Travmatik diyafragma rüptürlerinde mortaliteyi etkileyen faktörler; kunt travma, yüksek yaralanma şiddeti, şok varlığı, üç üniteden fazla kan transfüzyonu ve dalak yaralanmasıdır.