Indications for using video-assisted thoracoscopic surgery to diagnose diaphragmatic injuries after penetrating chest trauma

Background. Video-assisted thoracoscopic surgery (VATS) has been shown to b e an accurate method for identifying diaphragmatic injuries (DIs). The purp ose of this investigation was to establish specific indications for the use of VATS after penetrating chest trauma. Methods. A retrospective review of all patients undergoing VATS after penet rating chest trauma at a level 1 trauma center over an 8-year period was pe rformed. Logistic regression was used in an attempt to identify independent predictors of DI. Results. One hundred seventy-one patients underwent VATS assessment of a he midiaphragm, and 60 patients (35%) were found to have a DI. Five independen t risk factors for DI were identified from analyzing the patient records: a bnormal chest radiograph, associated intraabdominal injuries, high-velocity mechanism of injury, entrance wound inferior to the nipple line or scapula , and right-sided entrance wound. Conclusions. In the largest published series of patients undergoing VATS to exclude a DI, this review identifies five independent predictors of DI aft er penetrating chest trauma. A diagnostic algorithm incorporating these fiv e factors was designed with the goal of reducing the number of unrecognized DIs after penetrating chest trauma by using VATS for patients at greatest risk for such injuries. (C) 2001 by The Society of Thoracic Surgeons.