Article Figures & Data
Tables
- Table 1
Comparison of demographics and injury patterns of patients with diaphragm injury undergoing preoperative CT imaging
256-slice CT
(n=23)64-slice CT
(n=134)P values Demographics Age (years) 35.0 (28.8–40) 36.5 (27.0–50.3) 0.64 Gender (%) Male 20 (87.0) 106 (79.1) 0.34 Female 3 (13.0) 28 (20.9) Race (%) Caucasian 8 (34.7) 66 (49.3) 0.50 African–American 15 (65.2) 67 (50.0) Hispanic 0 1 (0.7) Clinical Mechanism of injury (%) Blunt 6 (26.1) 47 (35.1) 0.57 Penetrating 17 (73.9) 87 (64.9) Injury Severity Score 23.0 (16.5–41.0) 24.0 (14.0–34.0) 0.59 Associated injury (%) Hemothorax 17 (73.9) 86 (64.2) 0.53 Traumatic brain injury 2 (8.7) 8 (6.0) 0.67 Liver injury 12 (52.2) 74 (55.2) 0.64 Renal injury 4 (17.4) 8 (6.0) 0.069 Grade of renal injury 0 (0, 0) 0 (0, 0) Gastric injury 4 (17.4) 20 (14.9) 0.83 Small bowel injury 1 (4.3) 14 (10.4) 0.33 Colon injury 4 (17.4) 20 (14.9) 0.83 Pancreatic injury 2 (8.7) 6 (4.5) 0.43 Splenic injury 9 (39.1) 42 (31.3) 0.55 Data presented as median (IQR) unless otherwise noted.
Estimates from Pearson’s χ2 and Mann-Whitney U for categorical and continuous variables, respectively.
- Table 2
Comparison of patients with diaphragm injury undergoing preoperative CT imaging
256-slice CT
(n=23)64-slice CT
(n=134)P values Injury Diaphragm injury laterality (%) Left 16 (69.6) 77 (57.5) 0.43 Right 7 (30.4) 55 (41.0) Bilateral 0 2 (1.5) Diaphragm injury grade 3 (3, 3) 3 (2, 3) 0.65 1 0 5 (3.7) 0.32 2 0 25 (18.7) 0.02 3 19 (82.6) 58 (43.3) 0.002 4 2 (8.7) 27 (20.1) 0.13 5 0 0 – Length of injury (cm) 5.5 (2.0–8.8) 4.0 (2.0–10.0) 0.87 Visceral herniation with initial diagnosis (%) 6 (26.1) 23 (17.2) 0.36 Visceral herniation with delay in diagnosis (%) 0 2 (1.5) 0.55 Diagnosis with preoperative CT (%) 13 (56.5) 61 (45.5) 0.36 Diagnosis with X-ray (%) 0 9 (6.7) 0.19 Delay in diagnosis (%) 2 (8.7) 4 (3.0) 0.21 Operative Repair in index hospitalization (%) 23 (100) 124 (92.5) 0.17 Laparoscopy (%) 1 (4.3) 1 (0.7) 0.17 Thoracoscopy (%) 1 (4.3) 1 (0.7) 0.17 Laparotomy (%) 23 (100) 129 (96.3) 0.92 Thoracotomy (%) 1 (4.3) 11 (8.2) 0.49 Suture repair (%) 23 (100) 123 (91.8) 0.49 Mesh repair (%) 0 3 (2.2) 0.46 Data presented as median (IQR) unless otherwise noted.
Estimates from Pearson’s χ2 and Mann-Whitney U for categorical and continuous variables, respectively.
- Table 3
Comparison of the accuracy of CT in the identification of diaphragmatic injury among trauma patients prior to abdominal exploration
256-slice CT
(n=181)64-slice CT
(n=887)P values Overall True positive 13 (7.2) 61 (6.9) 0.88 True negative 148 (81.8) 739 (83.3) 0.61 False positive 10 (5.5) 14 (1.6) 0.001 False negative 10 (5.5) 73 (8.2) 0.22 Blunt True positive 5 (4.8) 28 (4.7) 0.98 True negative 90 (86.5) 537 (90.9) 0.17 False positive 7 (6.7) 8 (1.4) 0.001 False negative 2 (1.9) 18 (3.0) 0.53 Penetrating True positive 8 (10.4) 33 (11.1) 0.85 True negative 58 (75.3) 202 (68.2) 0.23 False positive 3 (3.9) 6 (2.0) 0.34 False negative 8 (10.4) 55 (18.6) 0.09 Left-sided True positive 9 (5.3) 35 (4.3) 0.54 True negative 148 (86.6) 739 (90.2) 0.41 False positive 7 (4.1) 5 (0.6) 0.03 False negative 7 (4.1) 40 (4.9) 0.69 Right-sided True positive 4 (2.5) 25 (3.1) 0.67 True negative 148 (93.7) 739 (91.8) 0.96 False positive 3 (1.9) 9 (1.1) 0.02 False negative 3 (1.9) 32 (4.0) 0.19 Data presented as number and proportion of patients with preoperative CT imaging.
Estimates from Pearson’s χ2 analysis.
- Table 4
Comparison of diagnostic ability of 64-slice and 256-slice CT scanners
Sensitivity (%) Specificity (%) Positive predictive value (%) Negative predictive value (%) Diagnostic accuracy (%) 64-slice Overall 45.5 98.1 81.3 91.0 90.2 Blunt 60.9 98.5 77.8 96.8 95.6 Penetrating 37.5 97.1 84.6 78.6 79.4 Left-sided injury 46.7 99.3 87.5 94.9 94.5 Right-sided injury 43.9 98.8 73.5 95.8 94.9 256-slice Overall 56.5 93.7 56.5 93.7 89.0 Blunt 71.4 92.8 41.7 97.8 91.3 Penetrating 50.0 95.1 72.7 87.9 85.7 Left-sided injury 56.3 95.5 56.3 95.5 91.8 Right-sided injury 57.1 98.0 57.1 98.0 96.2 - Table 5
Described signs on CT to identify diaphragm injury
Sign Description Collar Constriction of the viscera within the diaphragmatic defect (ie, collar too tight). Dependent viscera Viscera seen dependent on thoracic wall after herniating through the defect. Contiguous injury Injury tract visible on both sides of the diaphragm. Diaphragm thickening Thickening due to diaphragm retraction. Curled diaphragm Irregular diaphragm thickening. Hump Hump shape of the liver herniated through right-sided injury (similar to collar sign on the left). Band Linear area of hypoattenuation through herniated liver. Discontinuous diaphragm Focal defect in the diaphragm. Dangling diaphragm Free edge of the diaphragm curls inward toward the center of the body. Visceral herniation Herniation of organs into the thoracic cavity.
