Introduction:

Diaphragmatic injuries are a common finding in patients with penetrating thoracoabdominal trauma. Their diagnosis requires exploration through open or laparoscopic surgery. However, multislice computed tomography (MSCT) emerges as a useful noninvasive tool for this purpose.

Objective:

To determine the diagnostic performance of MSCT for detecting diaphragmatic injuries in hemodynamically stable patients with penetrating thoracoabdominal trauma.

Materials and methods:

Prospective study conducted on 119 patients treated at the Hospital Universitario del Valle, Cali, Colombia, between March 2012 and June 2015. In order to evaluate the diagnostic performance of MSCT, the results obtained through this test were compared with those reported in the reference test (open surgery). Two readings of the imaging studies were performed by 2 radiologists. Intra- and interobserver agreement on the MSCT readings were analyzed using the Fleiss' Kappa coefficient.

Results:

MSCT had sensitivity and specificity of 94.4% and 46.8%, respectively. Its positive (PPV) and negative (NPV) predictive values were 44.7% and 94.8%, respectively. The positive likelihood ratio (LR+) was 1.7765, and the negative likelihood ratio (LR-) was 0.1186. Regarding interobserver agreement, Fleiss' Kappa coefficient between the first reading of both radiologists was 0.4425.

Conclusions:

MSCT specificity for diagnosing diaphragmatic injuries found in this study differs considerably from that reported in the literature. Considering the sensitivity, PPV and LR- values obtained in the present study, MSCT could be an important tool for the management of these patients since conservative treatment may be used in patients whose diaphragmatic injuries are not detected with this type of scan.

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