Traumatic diaphragmatic injury (TDI) in children is rare and literature is scarce. The prevalence of penetrating injuries to children is increasing, as such incidence of diaphragmatic injury may rise. We report our centres 10-year experience of TDI.
A retrospective review of all children (<16) sustaining TDI was carried out using a prospectively maintained trauma database of major trauma activations between January 2007 and January 2018. Data collection included: patient demographics, mechanism of injury (MOI), concurrent injuries, injury severity score (ISS), management, length of stay and outcomes including mortality.
10 children sustained traumatic diaphragmatic injury during this time. 9 (90%) were male and 1 female (10%), 80% sustained penetrating injuries (7 stab wounds, 1 gunshot wound), 20% sustained blunt abdominal trauma (1 road traffic accident, 1 sports injury). Median age 14 (range 5-15) years. 90% patients sustained multiple concurrent injuries including haemo/pneumothorax and commonly laceration to liver, spleen and kidney. Injury severity scores (ISS) were high in all cases with a mean ISS 33 (range 9-54). 1 (10%) patient was managed conservatively (isolated stab wound right chest). Intervention was required for 9 (90%) including 4 (40%) isolated intercostal drain insertions, 4 (40%) laparotomy and repair of diaphragm and 2 (20%) requiring immediate trauma laparotomy +/- thoracotomy, due to code red haemorrhage. Median length of stay was 8 days (range 2-40). 2 patients died on the day of injury both due to associated un-survivable injury, morality rate 20%.
Traumatic diaphragmatic injury in children is rare. It is frequently associated with severe concurrent injury from which mortality rates and injury severity score are high. Simple diaphragm lacerations may be safely managed conservatively. Incidence is closely related to that of penetrating trauma which may be reduced through focused violence reduction schemes.