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Text
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URL Address
<a href="http://doi.org/10.1097/ta.0000000000001924" target="_blank" rel="noreferrer noopener">http://doi.org/10.1097/ta.0000000000001924</a>
Rights
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Pages
198-207
Issue
1
Volume
85
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Title
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Evaluation and management of traumatic diaphragmatic injuries: A Practice Management Guideline from the Eastern Association for the Surgery of Trauma
Publisher
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Journal of Trauma and Acute Care Surgery
Date
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2018
2018-07
Subject
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Surgery; laparoscopy; General & Internal Medicine; repair; computed-tomography; abdominal stab wounds; assisted thoracoscopic surgery; blunt; ct signs; diagnostic laparoscopy; diaphragm hernia; Diaphragm injuries; initial evaluation; penetrating thoracoabdominal trauma; practice management guidelines; rupture; thoracoscopy
Creator
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McDonald A A; Robinson B R H; Alarcon L; Bosarge P L; Dorion H; Haut E R; Juern J; Madbak F; Reddy S; Weiss P; Como J J
Description
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BACKGROUND Traumatic diaphragm injuries (TDI) pose both diagnostic and therapeutic challenges in both the acute and chronic phases. There are no published practice management guidelines to date for TDI. We aim to formulate a practice management guideline for TDI using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. METHODS The working group formulated five Patient, Intervention, Comparator, Outcome questions regarding the following topics: (1) diagnostic approach (laparoscopy vs. computed tomography); (2) nonoperative management of penetrating right-sided injuries; (3) surgical approach (abdominal or thoracic) for acute TDI, including (4) the use of laparoscopy; and (5) surgical approach (abdominal or thoracic) for delayed TDI. A systematic review was undertaken and last updated December 2016. RevMan 5 (Cochran Collaboration) and GRADEpro (Grade Working Group) software were used. Recommendations were voted on by working group members. Consensus was obtained for each recommendation. RESULTS A total of 56 articles were used to formulate the recommendations. Most studies were retrospective case series with variable reporting of outcomes measures and outcomes frequently not stratified to intervention or comparator. The overall quality of the evidence was very low for all Patient, Intervention, Comparator, Outcomes. Therefore, only conditional recommendations could be made. CONCLUSION Recommendations were made in favor of laparoscopy over computed tomography for diagnosis, nonoperative versus operative approach for right-sided penetrating injuries, abdominal versus thoracic approach for acute TDI, and laparoscopy (with the appropriate skill set and resources) versus open approach for isolated TDI. No recommendation could be made for the preferred operative approach for delayed TDI. Very low-quality evidence precluded any strong recommendations. Further study of the diagnostic and therapeutic approaches to TDI is warranted. LEVEL OF EVIDENCE Guideline; Systematic review, level IV.
Identifier
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<a href="http://doi.org/10.1097/ta.0000000000001924" target="_blank" rel="noreferrer noopener">10.1097/ta.0000000000001924</a>
Format
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Journal Article or Conference Abstract Publication
2018
abdominal stab wounds
Alarcon L
assisted thoracoscopic surgery
blunt
Bosarge P L
Como J J
computed-tomography
ct signs
diagnostic laparoscopy
diaphragm hernia
Diaphragm injuries
Dorion H
General & Internal Medicine
Haut E R
initial evaluation
Journal Article or Conference Abstract Publication
Journal of Trauma and Acute Care Surgery
Juern J
Laparoscopy
Madbak F
McDonald A A
penetrating thoracoabdominal trauma
practice management guidelines
Reddy S
repair
Robinson B R H
Rupture
Surgery
thoracoscopy
Weiss P