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Carlos H. Morales, MD; Maria I. Villegas, MD; Walter Angel, MD; John J. Vásquez, MD

Arch Surg. 2001;136:1131-1135.

Hypothesis  The digital exploration of stab wounds in the left thoracoabdominal region allows the early diagnosis of diaphragmatic lesions.

Design  Diagnostic test study. The digital exploration of the diaphragm was compared with laparotomy (the gold standard) and thoracoscopy.

Setting  The study setting was the Hospital Universitario San Vicente de Paúl (Medellín, Colombia). This is a referral trauma center for the general community.

Patients  The study included 82 consecutive patients who were admitted to our institution during a 12-month period with injuries caused by stab wounds to the left thoracoabdominal region and who did not have indications for immediate surgery. Digital exploration of the wound was performed by the attending surgeon in the emergency department. If a lesion of the diaphragm was identified, a laparotomy was performed; if no diaphragmatic lesion was found, a diagnostic left thoracoscopy and/or laparotomy was performed. Results of the laparotomy (n = 63) or thoracoscopy (n = 19) were used as the standard of reference for the determination of sensitivity, specificity, and predictive values of digital exploration.

Intervention  The integrity of the diaphragm was determined by digital exploration through the stab wound.

Main Outcome Measures  Sensitivity, specificity, predictive value, and likelihood ratio were calculated.

Results  For the detection of diaphragmatic lesions, digital exploration demonstrated a sensitivity of 96%, a specificity of 83.3%, a positive predictive value of 91%, and a negative predictive value of 93.7%.

Conclusion  Digital exploration is a reliable method for the detection of injuries to the left side of the diaphragm caused by stab wounds.

From the Department of Surgery, Universidad de Antioquia, Hospital Universitario San Vicente de Paúl (Drs Morales and Villegas), and the Universidad de Antioquia (Drs Angel and Vásquez), Medellín, Colombia.

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