Cristina De Padua (Rome / IT), Federica Scarno (Rome / IT), Immacolata Iannone (Rome / IT), Luigi Simonelli (Rome / IT), Paolo Sapienza (Rome / IT), Gioia Brachini (Rome / IT), Andrea Mingoli (Rome / IT)
Abstract text (incl. references and figure legends)
Post-traumatic diaphragmatic injuries are rare occurrence thus making the diagnosis difficult, in fact, 70% of them are missed. This delay rises the mortality rates up to 30%. Current diagnostic work-up consists of chest X-ray, followed by contrast-enhanced CT scan when the patient is hemodynamically stable. The aim of our study was to validate the selective use of diaphragm-extended E-FAST in hemodynamically unstable patients. The sensibility, specificity, positive and negative prognostic value of this tool was compared to the current diagnostic modalities (chest X-ray and CT scan).
From January 2018 to August 2022, 8 consecutive patients (M:F=5:3 – mean age: 53 years) affected with thoracic and abdominal blunt trauma and diaphragmatic injury were enrolled. The patients underwent a diaphragm-extended E-FAST, using a four acoustic windows on the anterior and lateral chest wall regions, a supine chest X-ray and a thoracic and abdominal CT scan.
All the patients were hemodynamically stable or responder at the fluid resuscitation. The injury dimensions ranged between 7 and 20 cm. The sensibility, the specificity and the positive and negative prognostic value of the supine chest X-ray were 65%, 77%, 80% and 50%, those of the E-FAST were 68%, 80%, 83% and 60%, and, finally, those of the CT scan were 95%, 97% 90% and 98%. All patients underwent an emergency laparotomy. The diaphragmatic ruptures were closed with direct sutures (no prothesis implantation). In 2 patients (25%) a splenectomy was performed. 1 patient (12%) died in the post-surgical period for AMI. No surgery-related complications were reported.
The diaphragm-extended E-FAST can be safely used as a reliable diagnostic tool in hemodynamically unstable patients who can"t be studied with CT scan, thus probably decreasing the risk of preoperative misdiagnoses.
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