Factors influencing mortality in traumatic ruptures of diaphragm.

Background: 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.

Conclusions: 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.