מתוך medicontext.co.il
WESTPORT, CT (Reuters Health) – Digital exploration can reliably determine whether the diaphragm has been violated after a stab wound to the left thoracoabdominal region, according to a report published in the October issue of the Archives of Surgery.
For many patients with penetrating injuries to the thoracoabdominal region it is unclear whether the diaphragm has been violated. Because delayed repair of left-sided diaphragmatic injuries is associated with high morbidity and mortality rates, it is imperative that these injuries are detected early.
Dr. Carlos H. Morales, from Universitario San Vicente de Paul in Medellin, Colombia, and colleagues studied digital exploration as a means of detecting left-sided diaphragm injuries in 82 consecutive patients who sustained stab wounds to the left thoracoabdominal region. None of the patients had indications for immediate surgery.
Digital exploration findings were compared with laparotomy findings in 63 patients and thoracoscopy findings in 19 patients, the researchers note.
They found that digital exploration was 96% sensitive and 83.3% specific in detecting left-sided diaphragmatic injuries. The positive and negative predictive values were 91% and 93.7%, respectively.
The investigators comment that digital exploration offers other advantages besides simplicity and accuracy, including no need for general anesthesia or additional incisions, low cost, and the ability to identify a large group of patients who require no further work-up.
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