Table 3.
Summary of findings in each study
| First author, year of publication | MOI | Important CT findings | Associated injuries | CT overall diagnostic accuracy |
|---|---|---|---|---|
| Augustin, 2019 | SW | NS | Thoracic new findings (pneumomediastinum, hemopneumothorax, pneumothorax, hemothorax, hemopericardium, ribs/scapula fracture) | Sen:50; Spe: 95; PPV:88; NPV: 72 |
| Bodanapally, 2009 | SW (43.38%) GSW (46.62%) Steel reinforcing bar injury (0.73%) | Contiguous injury sign on both sides of the diaphragm (the most accurate); Herniation of abdominal viscera into the thorax and the Collar sign (the most specific); Dependent viscera sign; Discontinuous diaphragm; Diaphragmatic thickening sign (the least specific) | Hemothorax, hemoperitoneum, splenic injury | Sen:87.2; Spe: 72.4; Accuracy: 77 |
| Dreizin, 2013 | SW (40.74%) GSW (59.26%) | Contiguous injury sign on both sides of the diaphragm (the most sensitive); Transdiaphragmatic trajectory (highly specific); Diaphragmatic discontinuity | NS | Sen: 86.67; Spe: 75; PPV: 81.25; NPV: 81.82 |
| Daza-Cajas, 2021 | GSW (85.71%) | Contiguous injury sign on both sides of the diaphragm (the most sensitive); Diaphragmatic discontinuity; Diaphragmatic thickening sign; Collar sign; Herniation of abdominal viscera into the thorax; Dependent viscera sign | Pleural effusion (n = 8)/Lung contusion (n = 12)/Pneumothorax (n = 23)/Hemoperitoneum (n = 40)/Liver injury (n = 32)/Splenic injury (n = 16)/Kidney injury (n = 17)/Hollow viscus injury (33)/Fracture (n = 7)/Pneumoperitoneum (n = 4) | Sen: 94.44; Spe: 46.84; PPV: 44.74; NPV: 94.87 |
| Leung, 2015 | SW (70.59)/ GSW (29.41) | Focal diaphragmatic defects; Collar sign; Dependent viscera sign; Herniation of abdominal viscera or fat into the thorax; Hump sign; Band sign (The latter two signs were observed in right-sided TDI) | Hemothorax; Pneumothorax; Hemoperitoneum; Pneumoperitoneum (total n = 16) | Sen: 33.3; Spe: 100; PPV:100; NPV: 57.1 |
| Melo, 2011 | GSW | Focal thickening and focal discontinuity of the diaphragm; Pleural effusion (in all TDI cases) | Pleural effusion (in all TDI cases), ipsilateral (in 3 cases), asymmetrically bilateral (remaining), larger on the injured side | Sen: 87.5; Spe: 100; PPV: 100; NPV: 95.83 |
| Stein, 2007 | SW (63.76%) GSW (36.24%) | Discrete diaphragmatic disruption; Herniation of abdominal viscera or fat into the thorax; Contiguous injury sign on both sides of the diaphragm; Foreign body within the muscle of the diaphragm | NS | Sen: 76; Spe: 98.1; PPV: 95; NPV: 89.5; Accuracy: 90.9 |
| Uhlich, 2018 | NS | Herniation of abdominal viscera or into the thorax; Collar sign; Dependent viscera sign; Contiguous injury sign on both sides of the diaphragm; Diaphragmatic thickening sign; Curled diaphragm; Hump sign; Band sign; Discontinuous diaphragm; Dangling diaphragm | Hemothorax, traumatic brain injury, liver, renal, gastric, intestinal, pancreatic, and plenic injuries | Sen: 39.42; Spe: 96.65; PPV: 82; NPV: 80.5 |
| Yucel, 2015 | SW | Injury line crossing the diaphragm; Loss of diaphragmatic integrity; Diaphragmatic irregularity | NS | Sen: 82; Spe: 88; PPV:70.14; NPV: 93.43 |
GSW Gunshot wound, MOI Mechanism of injury, NS Not specified, N Number, NPV Negative predictive value, PPV Positive predictive value, Sen sensitivity, Spe specificity, SW stab wound, TDI Traumatic diaphragmatic injury