Value of Ultrasonography in Detection of Diaphragmatic Injuries Following Thoracoabdominal Penetrating Trauma; a Diagnostic Accuracy Study
学术急诊医学档案,
卷 7 编号 1 (2019),
1 一月 2019
,
第 e45 页
https://doi.org/10.22037/aaem.v7i1.382
摘要
Introduction: Diagnosis of diaphragmatic rupture following thoracoabdominal penetrating trauma is very challenging in asymptomatic patients with stable vital signs. This study aimed to evaluate the diagnostic accuracy of focused assessment with sonography for trauma (FAST) in this regard.
Methods: This cross-sectional study was performed on patients referring to emergency department due to left thoracoabdominal stab wound during 2 years. All patients initially underwent ultrasonography and the screening performance characteristics of FAST in detection of diaphragmatic injuries were calculated, considering the findings of diagnostic laparoscopy as the gold standard test.
Results: Twenty-four patients with the mean age of 33 ± 10.64 years (16-61 years) were studied (100% male). The mean chest wall laceration size was 2.7 ± 2.7 cm (1-10 cm) and the most frequent location of wounds was posterior chest wall (42%) and in the 6th and 7th intercostal space (50%). Diaphragmatic rupture was seen in 4 (16.7%) patients based on diagnostic laparoscopy. Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratio of FAST in detection of diaphragmatic raptures were 50% (95% CI: 9.18 – 90.8), 100% (95% CI: 79.9 – 100.0), 100% (95% CI: 19.8 – 100.0), 9.1% (95% CI: 1.5 – 30.6), Infinity, and 0.1 (95% CI: 0.02 – 0.37), respectively. The overall accuracy of FAST in this regard was 75.0% (95% CI: 42.3 – 100.0).
Conclusion: In patients with penetrating trauma to the left thoracoabdominal region, FAST cannot be the definitive alternative to diagnostic laparoscopy to detect diaphragm rupture.
- Wounds
- stab
- diaphragm
- wounds and injuries
- focused assessment with sonography of trauma
- laparoscopy
##submission.howToCite##
参考
Edelmuth RC, Buscariolli Ydos S, Ribeiro MA, Jr. [Damage control surgery: an update]. Revista do Colegio Brasileiro de Cirurgioes. 2013;40(2):142-51.
Boyle EM, Jr., Maier RV, Salazar JD, Kovacich JC, O'Keefe G, Mann FA, et al. Diagnosis of injuries after stab wounds to the back and flank. The Journal of trauma. 1997;42(2):260-5.
Bagheri R, Tavassoli A, Sadrizadeh A, Mashhadi MR, Shahri F, Shojaeian R. The role of thoracoscopy for the diagnosis of hidden diaphragmatic injuries in penetrating thoracoabdominal trauma. Interactive cardiovascular and thoracic surgery. 2009;9(2):195-7; discussion 7-8.
Murray JA, Demetriades D, Cornwell EE, 3rd, Asensio JA, Velmahos G, Belzberg H, et al. Penetrating left thoracoabdominal trauma: the incidence and clinical presentation of diaphragm injuries. The Journal of trauma. 1997;43(4):624-6.
Hosseini M, Ghelichkhani P, Baikpour M, Tafakhori A, Asady H, Haji Ghanbari MJ, et al. Diagnostic Accuracy of Ultrasonography and Radiography in Detection of Pulmonary Contusion; a Systematic Review and Meta-Analysis. Emergency (Tehran, Iran). 2015;3(4):127-36.
Yousefifard M, Baikpour M, Ghelichkhani P, Asady H, Shahsavari Nia K, Moghadas Jafari A, et al. Screening Performance Characteristic of Ultrasonography and Radiography in Detection of Pleural Effusion; a Meta-Analysis. Emergency (Tehran, Iran). 2016;4(1):1-10.
Rahimi-Movaghar V, Yousefifard M, Ghelichkhani P, Baikpour M, Tafakhori A, Asady H, et al. Application of ultrasonography and radiography in detection of hemothorax; a systematic review and meta-analysis. 2016;4(3):116.
Lingawi SS, Buckley AR. Focused abdominal US in patients with trauma. Radiology. 2000;217(2):426-9.
Cherry RA, Eachempati SR, Hydo LJ, Barie PS. The role of laparoscopy in penetrating abdominal stab wounds. Surgical laparoscopy, endoscopy & percutaneous techniques. 2005;15(1):14-7.
Chol YB, Lim KS. Therapeutic laparoscopy for abdominal trauma. Surgical endoscopy. 2003;17(3):421-7.
Yucel M, Ozpek A, Tolan HK, Basak F, Bas G, Unal E, et al. Importance of diagnostic laparoscopy in the assessment of the diaphragm after left thoracoabdominal stab wound: A prospective cohort study. Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES. 2017;23(2):107-11.
Yucel M, Bas G, Kulali F, Unal E, Ozpek A, Basak F, et al. Evaluation of diaphragm in penetrating left thoracoabdominal stab injuries: The role of multislice computed tomography. Injury. 2015;46(9):1734-7.
Mjoli M, Oosthuizen G, Clarke D, Madiba T. Laparoscopy in the diagnosis and repair of diaphragmatic injuries in left-sided penetrating thoracoabdominal trauma: laparoscopy in trauma. Surgical endoscopy. 2015;29(3):747-52.
Tayal VS, Beatty MA, Marx JA, Tomaszewski CA, Thomason MH. FAST (focused assessment with sonography in trauma) accurate for cardiac and intraperitoneal injury in penetrating anterior chest trauma. Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine. 2004;23(4):467-72.
- 摘要 ##plugins.themes.ojsPlusA.frontend.article.viewed##: 429 ##plugins.themes.ojsPlusA.frontend.article.times##
- PDF (English) ##plugins.themes.ojsPlusA.frontend.article.downloaded##: 272 ##plugins.themes.ojsPlusA.frontend.article.times##
- HTML (English) ##plugins.themes.ojsPlusA.frontend.article.downloaded##: 70 ##plugins.themes.ojsPlusA.frontend.article.times##
##plugins.themes.ojsPlusA.frontend.article.downloadstatastics##
##plugins.block.makeSubmission.linkLabel##
SJR
COPE
