Ch. Morales et al., Value of digital exploration for diagnosing injuries to the left side of the diaphragm caused by stab wounds, ARCH SURG, 136(10), 2001, pp. 1131-1135
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.