Diaphragmatic rupture and the association with occupant position in right-hand drive vehicles

Ruptured diaphragm following blunt trauma occurs with an incidence of 3 to 8% with right-sided rupture recognised with increasing frequency. This stud y aimed to investigate the influence of occupant position in right-hand dri ve (RHD) vehicles on the side of diaphragmatic injury. A retrospective anal ysis of the Scottish Trauma Audit Group database was performed to gather da ta on blunt diaphragmatic lacerations. Police records were also searched to ascertain the point of impact in the accidents studied. In total, 35 patie nts were studied, 25 drivers and 10 front-seat passengers. The incidence of right-sided rupture was 40% in drivers and 20% in FSPs. The incidence of a ssociated pulmonary contusion, rib fracture and liver injury was also highe r in drivers. Given the small sample size, these differences were not stati stically significant, but they show an interesting trend. The right side of a driver's body is more exposed to injury in RHD vehicles, a fact that exp lains the significant association between driver's side impact and right-si ded rupture. As right-sided injury is more difficult to detect, it is impor tant that a hi.-h index of suspicion is maintained, especially when managin g drivers from RHD vehicles. (C) 2001 Elsevier Science Ltd. All rights rese rved.