Traumatic diaphragmatic injuries in blunt and penetrating trauma in a European trauma centre

Traumatic diaphragmatic injury is an uncommon but clinically important consequence of thoracoabdominal trauma. Diagnosis remains challenging because imaging findings may be subtle. We aimed to describe the clinical characteristics, imaging findings, management, and outcomes of surgically confirmed traumatic diaphragmatic injuries treated at a European trauma centre.

We conducted a retrospective descriptive case series including all patients with surgically confirmed traumatic diaphragmatic injury who underwent surgery between January 2019 and December 2023. Data included demographics, trauma characteristics, imaging findings, operative management, and postoperative outcomes.

Thirty-nine patients were included (median age 38 [IQR 22-55] years; 87% male); 29 (74%) sustained penetrating trauma and 10 (26%) blunt trauma. The median Injury Severity Score was 19 (IQR 14-31). Preoperative CT was performed in 35 patients (90%), and the diaphragmatic injury was reported on the initial CT in only 60% of these patients. Overall, 23 patients (59%) had extra-abdominal injuries, 12 (31%) experienced major complications (Clavien-Dindo > IIIa), and four (10%) died within 30 days. Patients with blunt trauma generally had greater injury severity, more associated injuries, and poorer outcomes than those with penetrating trauma.

Traumatic diaphragmatic injury remains a challenging diagnosis. In this descriptive case series, the diaphragmatic injury was reported on the initial CT in only 60% of patients who underwent preoperative CT, highlighting the importance of maintaining a high index of suspicion and systematically evaluating the diaphragm during trauma CT interpretation. Larger prospective studies are needed to better define the diagnostic performance of modern CT and optimize management.