Value of digital exploration for diagnosing injuries to the left side of the diaphragm caused by stab wounds

Hypothesis: The digital exploration of stab wounds in the left thoracoabdom inal region allows the early diagnosis of diaphragmatic lesions. Design: Diagnostic Lest study. The digital exploration of the diaphragm was compared with laparotomy (the gold standard) and thoracoscopy. Setting: The study setting was the Hospital Universitario San Vicente de Pa ul (Medellin, Colombia). This is a referral trauma center for the general c ommunity. Patients: The study included 82 consecutive patients who were admitted to o ur institution during a 12-month period with injuries caused by stab wounds to the left thoracoabdominal region and who did not have indications for i mmediate surgery. Digital exploration of the wound was performed by the att ending surgeon in the emergency department. If a lesion of the diaphragm wa s identified, a laparotomy was performed; if no diaphragmatic lesion was fo und, a diagnostic left thoracoscopy and/or laparotomy was performed. Result s of the laparotomy (n = 63) or thoracoscopy (n = 19) were used as the stan dard of reference for the determination of sensitivity, specificity, and pr edictive values of digital exploration. Intervention: The integrity of the diaphragm was determined by digital expl oration through the stab wound. Main Outcome Measures: Sensitivity, specificity, predictive value, and like lihood ratio were calculated. Results: For the detection of diaphragmatic lesions, digital exploration de monstrated a sensitivity of 96%, a specificity of 83.3%, a positive predict ive value of 91%, and a negative predictive value of 93.7%. Conclusion: Digital exploration is a reliable method for the detection of i njuries to the left side of the diaphragm caused by stab wounds.