RESUMO
This study was conducted in a level I trauma centre to review the outcome of surgical repair of Traumatic Diaphragmatic Rupture [TDR] and to identify the predictors of mortality and hospital stay. Between January 1990 and January 2001, consecutive patients with TDR and ISS [Injury Severity Score] > 12 were identified from a prospective trauma registry. Hospital charts of all eligible patients were reviewed for demographic data, mechanism of injury, mode of diagnosis, type of surgical repair, need for ventilatory support, ICU and hospital stay and mortality. We conducted a stepwise regression analysis [logistic regression for mortality, and multiple regressions for hospital stay]. Of the 59 patients included in the study 44 [75%] were males. Their mean age was 43 +/- 18 years and their average ISS was 39 +/- 15 Blunt injuries [85%] and left sided ruptures [73%] were the most common. Frontal and side impacts were equally distributed. Twenty eight [66%] patients were drivers. Forty five [79%] patients were ventilated following the diaphragm repair. A significantly higher proportion of patients with blunt injuries required ventilatory support compared with penetrating injuries [93% vs. 38%, p <0.05]. The mortality rate was 7%. Older age was a significant predictor of mortality [Odds ratio = 1.2, 95% CI = 1.1-1.4, P = 0.04]. ISS [Odds ratio =1.1, 95% CI = 0.98 -1.2, P = 0.08] and need for ventilation [Odds ratio=1.02, 95% CI = 0.97-1.12, P=0.09] revealed trends towards mortality, but were not statistically significant. Hospital stay was predicted by the ISS [B=0.09, P=0.05] score and need for postoperative ventilatory support [B=0.26, P=0.04]. This is the largest Canadian series from a single trauma centre. it revealed that older age is a major predictor of mortality whereas the need for ventilatory support did not predict the overall mortality