Penetrating diaphragmatic injuries are associated with a high incidence of posttraumatic empyema. We analyzed the contribution of trauma severity, specific organ injury, contamination severity, and surgical management to the risk of posttraumatic empyema in patients who underwent surgical repair of diaphragmatic injuries at a level 1 trauma center. This is a retrospective review of the patients who survived more than 48 h. Univariate OR calculations were performed to identify potential risk factors. Multiple logistic regression was used to calculate adjusted ORs and identify independent risk factors. We included 192 patients treated from 2011 to 2020. There were 169 (88.0) males. The mean interquartile range, (IQR) of age, was 27 (22–35) years. Gunshot injuries occurred in 155 subjects (80.7%). Mean (IQR) NISS and ATI were 29 (18–44) and 17 (10–27), respectively. Thoracic AIS was > 3 in 38 patients (19.8%). Hollow viscus was injured in 105 cases (54.7%): stomach in 65 (33.9%), colon in 52 (27.1%), small bowel in 42 (21.9%), and duodenum in 10 (5.2%). Visible contamination was found in 76 patients (39.6%). Potential thoracic contamination was managed with a chest tube in 128 cases (66.7%), with transdiaphragmatic pleural lavage in 42 (21.9%), and with video-assisted thoracoscopy surgery or thoracotomy in 22 (11.5%). Empyema occurred in 11 patients (5.7%). Multiple logistic regression identified thoracic AIS > 3 (OR 6.4, 95% CI 1.77–23. 43), and visible contamination (OR 5.13, 95% IC 1.26–20.90) as independent risk factors. The individual organ injured, or the method used to manage the thoracic contamination did not affect the risk of posttraumatic empyema. The severity of the thoracic injury and the presence of visible abdominal contamination were identified as independent risk factors for empyema after penetrating diaphragmatic trauma.

中文翻译：

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膈肌损伤创伤后脓胸的危险因素

穿透性膈肌损伤与创伤后脓胸的高发病率有关。我们分析了创伤严重程度、特定器官损伤、污染严重程度和手术管理对在一级创伤中心接受膈肌损伤手术修复的患者的创伤后脓胸风险的影响。这是对存活超过 48 小时的患者的回顾性研究。进行单变量或计算以确定潜在的风险因素。多元逻辑回归用于计算调整后的 OR 并确定独立的风险因素。我们纳入了 2011 年至 2020 年接受治疗的 192 名患者。其中男性 169 名 (88.0)。年龄的平均四分位距 (IQR) 为 27 (22-35) 岁。155 名受试者 (80.7%) 发生枪伤。平均 (IQR) NISS 和 ATI 分别为 29 (18-44) 和 17 (10-27)。38 名患者 (19.8%) 的胸部 AIS > 3。中空脏器损伤105例（54.7%）：胃65例（33.9%），结肠52例（27.1%），小肠42例（21.9%），十二指肠10例（5.2%）。在 76 名患者 (39.6%) 中发现了可见污染。128 例 (66.7%) 采用胸管处理潜在的胸部污染，42 例 (21.9%) 采用经膈胸腔灌洗，22 例 (11.5%) 采用电视辅助胸腔镜手术或开胸手术。11 名患者 (5.7%) 出现脓胸。多元逻辑回归将胸部 AIS > 3 (OR 6.4, 95% CI 1.77–23. 43) 和可见污染 (OR 5.13, 95% IC 1.26–20.90) 确定为独立危险因素。个别器官受伤，或用于管理胸部污染的方法不影响创伤后脓胸的风险。胸部损伤的严重程度和可见腹部污染的存在被确定为穿透性膈外伤后脓胸的独立危险因素。