Characteristics, outcomes, and prognostic factors in patients with penetrating and blunt traumatic diaphragmatic injury: a nationwide retrospective cohort study in Japan
Dublin Core
Title
Characteristics, outcomes, and prognostic factors in patients with penetrating and blunt traumatic diaphragmatic injury: a nationwide retrospective cohort study in Japan
Subject
Traumatic diaphragmatic injury (TDI), Penetrating TDI (PTDI), Blunt TDI (BTDI), Japan Trauma Data Bank
(JTDB), Associated injury, Severe concomitant injury, Independent predictor of mortality, Epidemiology
(JTDB), Associated injury, Severe concomitant injury, Independent predictor of mortality, Epidemiology
Description
Abstract
Background Traumatic diaphragmatic injury (TDI) is well-known worldwide as rare and life-threatening. However,
because no nationwide cohort study of penetrating and blunt TDI has been conducted in Japan and other coun-
tries where penetrating trauma is relatively uncommon, the clinical characteristics of all TDI are unknown. We aimed
to describe the characteristics of TDI patients, compare penetrating TDI with blunt TDI, and identify mortality risk
factors in Japan.
Methods We retrospectively identified TDI patients between 2004 and 2019 using data from the Japan Trauma Data
Bank. We extracted data on patient demographics, type of trauma, cause of trauma, physiological parameters, region
of concomitant injury, associated injury, and management. We compared penetrating and blunt TDI for each variable.
The primary outcome was mortality. Multivariable logistic regression was performed to identify mortality risk factors.
Results Of the 338,744 patients, 1,147 (0.3%) had TDI, of which 771 were eligible for analysis (excluding 308 in cardiac
arrest on arrival). Penetrating TDI represented 29.8% and blunt TDI 70.2%, and comparing penetrating and blunt TDI,
the most common cause was self-inflicted (48.7%) vs. accident (85.6%), males were 68.7% vs. 66.0% of the patients
(P=0.50), and the mortality rate was 8.3% vs. 26.4% (P<0.001). Multivariable analysis found that age (odds ratio [OR]
1.03, 95% confidence interval [CI] 1.01–1.04), Injury Severity Score (OR 1.03, 95%CI 1.006–1.06), Revised Trauma Score
(OR 0.55, 95%CI 0.45–0.67), severe concomitant abdominal injury (OR 2.45, 95%CI 1.32–4.56), severe concomitant
upper extremity injury (OR 3.38, 95%CI 1.24–9.17) were independent predictors of mortality, and computed tomogra-
phy (CT) (OR 0.32, 95%CI 0.15–0.69) and diaphragm repair (OR 0.44, 95%CI 0.25–0.78) were protective factors.
Conclusions In Japan, we found that penetrating TDI was mainly caused by self-injury and the male–female ratio
was the same as for blunt TDI, although blunt TDI was much more frequent. TDI was considered highly lethal,
with over 25% of patients in cardiac arrest on arrival. Our unique independent predictors were CT, severe concomitant
abdominal injury, and severe concomitant upper extremity injury. These findings may help in the management of TDI
in countries with less common penetrating trauma.
Keywords Traumatic diaphragmatic injury (TDI), Penetrating TDI (PTDI), Blunt TDI (BTDI), Japan Trauma Data Bank
(JTDB), Associated injury, Severe concomitant injury, Independent predictor of mortality, Epidemiology
Background Traumatic diaphragmatic injury (TDI) is well-known worldwide as rare and life-threatening. However,
because no nationwide cohort study of penetrating and blunt TDI has been conducted in Japan and other coun-
tries where penetrating trauma is relatively uncommon, the clinical characteristics of all TDI are unknown. We aimed
to describe the characteristics of TDI patients, compare penetrating TDI with blunt TDI, and identify mortality risk
factors in Japan.
Methods We retrospectively identified TDI patients between 2004 and 2019 using data from the Japan Trauma Data
Bank. We extracted data on patient demographics, type of trauma, cause of trauma, physiological parameters, region
of concomitant injury, associated injury, and management. We compared penetrating and blunt TDI for each variable.
The primary outcome was mortality. Multivariable logistic regression was performed to identify mortality risk factors.
Results Of the 338,744 patients, 1,147 (0.3%) had TDI, of which 771 were eligible for analysis (excluding 308 in cardiac
arrest on arrival). Penetrating TDI represented 29.8% and blunt TDI 70.2%, and comparing penetrating and blunt TDI,
the most common cause was self-inflicted (48.7%) vs. accident (85.6%), males were 68.7% vs. 66.0% of the patients
(P=0.50), and the mortality rate was 8.3% vs. 26.4% (P<0.001). Multivariable analysis found that age (odds ratio [OR]
1.03, 95% confidence interval [CI] 1.01–1.04), Injury Severity Score (OR 1.03, 95%CI 1.006–1.06), Revised Trauma Score
(OR 0.55, 95%CI 0.45–0.67), severe concomitant abdominal injury (OR 2.45, 95%CI 1.32–4.56), severe concomitant
upper extremity injury (OR 3.38, 95%CI 1.24–9.17) were independent predictors of mortality, and computed tomogra-
phy (CT) (OR 0.32, 95%CI 0.15–0.69) and diaphragm repair (OR 0.44, 95%CI 0.25–0.78) were protective factors.
Conclusions In Japan, we found that penetrating TDI was mainly caused by self-injury and the male–female ratio
was the same as for blunt TDI, although blunt TDI was much more frequent. TDI was considered highly lethal,
with over 25% of patients in cardiac arrest on arrival. Our unique independent predictors were CT, severe concomitant
abdominal injury, and severe concomitant upper extremity injury. These findings may help in the management of TDI
in countries with less common penetrating trauma.
Keywords Traumatic diaphragmatic injury (TDI), Penetrating TDI (PTDI), Blunt TDI (BTDI), Japan Trauma Data Bank
(JTDB), Associated injury, Severe concomitant injury, Independent predictor of mortality, Epidemiology
Creator
Takafumi Shinjo1*, Yoshimitsu Izawa1
, Chikara Yonekawa1
, Tomohiro Matsumura1 and Takashi Mato1
, Chikara Yonekawa1
, Tomohiro Matsumura1 and Takashi Mato1
Source
https://doi.org/10.1186/s12245-025-00826-2
Date
2025
Contributor
Peri Irawan
Format
pdf
Language
english
Type
text
Files
Collection
Citation
Takafumi Shinjo1*, Yoshimitsu Izawa1
, Chikara Yonekawa1
, Tomohiro Matsumura1 and Takashi Mato1, “Characteristics, outcomes, and prognostic factors in patients with penetrating and blunt traumatic diaphragmatic injury: a nationwide retrospective cohort study in Japan,” Repository Horizon University Indonesia, accessed April 25, 2026, https://repository.horizon.ac.id/items/show/12656.