Injury to the diaphragm: Our experience in Union Head quarters Hospital

Radjou, Angeline Neetha; Balliga, Dillip Kumar; Uthrapathy, Muthandavan; Pal, Ranabir; Mahajan, Preetam

doi:10.4103/2229-5151.124139

Cited by 9 publications

(7 citation statements)

References 25 publications

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“…Table 4 summarizes the most recent TDI studies from different countries [1,3,[14][15][16][17][18][19][20][21][22][23][24][25][26][27]. However, we may underestimate the incidence of TDI as the majority of mild (missed) or severe (died before diagnosis) lesions can be difficult to diagnose or because of the unavailability of routine postmortem examination in the state of Qatar.…”

Section: Discussionmentioning

confidence: 99%

Descriptive Analysis of Right and Left-sided Traumatic Diaphragmatic Injuries; Case Series from a Single Institution

Al-Thani

Jabbour

El‐Menyar

et al. 2018

BEAT

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Objective: To investigate the presentation, management and outcomes of left and right-sided traumatic diaphragmatic injury (TDI) in a single level I trauma center. Methods: This cross-sectional study was conducted during a 7-year period from 2008 to 2015 in a level I trauma center in Qatar. We included all the patients who presented with TDIs during the study period. Data included demographics, mechanism of injury, associated injuries, initial vitals, emergency department disposition, length of ICU and hospital stay, ventilator days, management, and outcomes. The variables were analyzed and compared for patients with left (LTDI) and right (RTDI). Results: A total of 52 TDI cases (79% LTDI and 21% RTDI) were identified with a mean age of 31±11. LTDI patients were more likely to have higher Injury severity scores (p=0.50) and greater AAST organ injury scoring (p=0.661 for all) than RTDI patients. Surgical repair was performed for 85% LTDI vs. 73% RTDI (p= 0.342). Recurrent DIs was reported only in LTDI (5.1% vs. 0.0%; p=0.911). Twelve patients died (9 LTDI and 3 RTDI), of them 5 had associated head injury. Conclusion: This single-institution study confirms that LTDI are more commonly diagnosed than RTDI. Exploratory laparotomy is the most frequent procedure considered for the management of diaphragmatic injuries in the emergency settings. To improve outcomes in patients presenting with TDI, large prospective multicenter studies are needed to standardize the TDI management protocols including the diagnostic workup, timing of surgical intervention, and the most appropriate approach of treatment.

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Section: Discussionmentioning

confidence: 99%

Descriptive Analysis of Right and Left-sided Traumatic Diaphragmatic Injuries; Case Series from a Single Institution

Al-Thani

Jabbour

El‐Menyar

et al. 2018

BEAT

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“…[15][16][17][18] Our data suggest that, although some identified injuries may not have been previously detected, this increase is not incidental since the surgical intervention rate remained stable. Nonetheless, ELTIs discovered by radiologic investigation as a result of the investigation protocol or targeted evaluation in cases in which such an injury does not seem likely should be evaluated urgently given the potential for long-term sequelae if left unrepaired.…”

Section: Discussionmentioning

confidence: 86%

Airway management changes associated with rising radiologic incidence of external laryngotracheal injury

Randall

Rudmik

Ball³

et al. 2018

cjs

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Background: Traumatic laryngeal injuries are uncommon life-threatening injuries that require prompt, rational management of a potentially precarious airway. It is unclear whether the current incidence of laryngotracheal injury is due to enhanced injury detection or increased occurrence. The objective of this study was to evaluate the relations between diagnostic imaging with both initial airway management and surgical treatment in patients with external laryngotracheal injuries (ELTIs) in Alberta. Methods:In this large-scale population-based analysis, we used regional health databases containing inpatient admissions, emergency department visits and trauma service activations employing International Classification of Diseases diagnostic codes to identify all ELTIs diagnosed from Apr. 1, 1995, to Dec. 31, 2011, in adults (age ≥ 16 yr). We evaluated health records and diagnostic imaging for injury features, airway management, operative interventions and hospital length of stay (LOS).Results: Eighty-nine patients met the inclusion criteria. The incidence of ELTIs increased over time, paralleling a rise in detection during the period incorporating greater computed tomography (CT) use (p = 0.002). Endotracheal tube intubation was performed in 8/30 cases (27%) in the pre-CT era, compared to 38/59 cases (64%) in the post-CT era (p = 0.001); the use of surgical intervention remained consistent. The largest contributors to increased endotracheal tube placements were the emergency department and emergency medical services. No change in survival was detected, but mean LOS among patients admitted for minor, isolated ELTIs increased by 2.3 (95% confidence interval 0.14-4.8) days (p = 0.06), mostly for patients admitted under critical care for mechanical ventilation. Conclusion:Management of ELTIs shifted from predominantly conservative airway monitoring to endotracheal tube intubation over the study period in spite of no clinically significant change in injury severity or operative intervention frequency. The location of endotracheal tube placement suggests less comfort with ELTI among first-responder and emergency personnel.

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“…Mean Injury Severity Score (ISS) was significantly related to fatal outcomes irrespective of mechanism. [ 60 ]…”

Section: Risk Factorsmentioning

confidence: 99%

The 2014 Academic College of Emergency Experts in India′s INDO-US Joint Working Group (JWG) White Paper on "Developing Trauma Sciences and Injury Care in India"

Pal

Agarwal

Galwankar

et al. 2014

Int J Crit Illn Inj Sci

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It is encouraging to see the much needed shift in the understanding and recognition of the concept of “burden of disease” in the context of traumatic injury. Equally important is understanding that the impact of trauma burden rivals that of nontraumatic morbidities.Subsequently, this paradigm shift reinstates the appeal for timely interventions as the standard for management of traumatic emergencies. Emergency trauma care in India has been disorganized due to inadequate sensitivity toward patients affected by trauma as well as the haphazard, nonuniform acceptance of standardization as the norm. Some of the major hospitals across various regions in the country do have trauma care units, but even those lack protocols to ensure that all trauma cases are handled by those units, largely owing to lack of structured referral system.As a first step to reform the state of trauma care in the country, a detailed overview is needed to gain insight into the prevailing reality. The objectives of this paper are to thus weave a foundation based on the statistical and qualitative burden of trauma in the country; the available infrastructure of trauma care centers equipped to deal with trauma; the need and scope of standardized protocols for intervention; and most importantly, the application of these in shaping educational initiatives in advancing emergency trauma care in the country.

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Injury to the diaphragm: Our experience in Union Head quarters Hospital

Cited by 9 publications

References 25 publications

Descriptive Analysis of Right and Left-sided Traumatic Diaphragmatic Injuries; Case Series from a Single Institution

Descriptive Analysis of Right and Left-sided Traumatic Diaphragmatic Injuries; Case Series from a Single Institution

Airway management changes associated with rising radiologic incidence of external laryngotracheal injury

The 2014 Academic College of Emergency Experts in India′s INDO-US Joint Working Group (JWG) White Paper on "Developing Trauma Sciences and Injury Care in India"

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