TY - JOUR
T1 - Delayed detection of a traumatic diaphragmatic injury caused by positive pressure ventilation
T2 - A case report and a proposed system of classification of delayed diagnosis of traumatic injuries
AU - Kligman, Mark
AU - Saxe, Jonathan
AU - Hai, Shaikh
PY - 2005/7/1
Y1 - 2005/7/1
N2 - The establishment of regional trauma centers in the United States has resulted in a significant reduction in morbidity and mortality from traumatic injuries. It has also led to a decrease in the incidence of delayed diagnosis of injuries ("missed injuries"), which are not detected during the initial evaluation of these patients. The surgeon managing an acutely injured trauma patient in the initial "golden hour" is faced with leadership, organizational, diagnostic, and therapeutic challenges. The algorithmic approach to the care of the trauma patient has led to the development of protocols to eliminate or at least reduce the incidence of these undetected injuries. The majority of these missed injuries are difficult to reliably detect by conventional diagnostic modalities, are usually asymptomatic, or attention was erroneously diverted to other more overt injuries. We report a case of a patient who sustained a traumatic laceration of his left hemi-diaphragm, which was detected only after positive pressure mechanical ventilation was discontinued. A proposed system of classification of delayed diagnoses is also presented.
AB - The establishment of regional trauma centers in the United States has resulted in a significant reduction in morbidity and mortality from traumatic injuries. It has also led to a decrease in the incidence of delayed diagnosis of injuries ("missed injuries"), which are not detected during the initial evaluation of these patients. The surgeon managing an acutely injured trauma patient in the initial "golden hour" is faced with leadership, organizational, diagnostic, and therapeutic challenges. The algorithmic approach to the care of the trauma patient has led to the development of protocols to eliminate or at least reduce the incidence of these undetected injuries. The majority of these missed injuries are difficult to reliably detect by conventional diagnostic modalities, are usually asymptomatic, or attention was erroneously diverted to other more overt injuries. We report a case of a patient who sustained a traumatic laceration of his left hemi-diaphragm, which was detected only after positive pressure mechanical ventilation was discontinued. A proposed system of classification of delayed diagnoses is also presented.
KW - Classification
KW - Delayed diagnosis
KW - Diaphragmatic injuries
KW - Missed injuries
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M3 - Article
C2 - 16465997
AN - SCOPUS:33646448278
VL - 90
SP - 125
EP - 129
JO - International Surgery
JF - International Surgery
SN - 0020-8868
IS - 3
ER -