Diagnostic Accuracy of Computed Tomography Versus Diagnostic Laparoscopy for Detecting Diaphragmatic Injury in Left Thoracoabdominal Penetrating Trauma: A Systematic Review and Meta-Analysis
In brief
CT misses about 3 in 10 diaphragm injuries after penetrating trauma
In a meta-analysis of four studies involving 222 patients, CT detected 70% of left-sided diaphragm injuries and correctly ruled out injury in 94% of patients without one. A negative CT therefore cannot reliably exclude injury; diagnostic laparoscopy remains the reference standard and allows immediate repair, though the evidence base is small.
- Journal
- World journal of surgery (Q1)
- Published
- 26 October 2026
- Study design
- Systematic review of cohort studies
- Evidence level
- Level 2, Moderate (CEBM 2a)
- Authors
- Mozamil Mohamed, Shumani Makhadi, Maeyane S Moeng
- PMID
- 42929170
- DOI
- 10.1002/wjs.70645
Why clinicians should know about it
- Picked for Emergency Medicine (paper of the day, 27 October 2026): Diagnostic accuracy informs exclusion of occult penetrating diaphragmatic injury
Abstract
BACKGROUND: Occult diaphragmatic injury occurs in 17%-54% of patients with left thoracoabdominal penetrating trauma and carries a substantial risk of delayed herniation, bowel strangulation, and mortality if missed. The comparative diagnostic performance of multidetector computed tomography (CT) and diagnostic laparoscopy (DL) in this specific population remains incompletely defined. METHODS: A systematic review was conducted according to the PRISMA-DTA statement. PubMed/MEDLINE, Scopus, Cochrane Library, and Google Scholar were searched from inception to August 2026. Diagnostic accuracy studies reporting CT findings against a surgical reference standard in adult patients with left thoracoabdominal penetrating trauma were included. The methodological quality was assessed with QUADAS-2. A bivariate random-effects model was used for pooled estimates. RESULTS: Four primary diagnostic accuracy studies (222 patients with extractable 2 × 2 data) were included. Individual sensitivities of CT ranged from 50% to 82% and specificities from 88% to 100%. The pooled sensitivity of CT was 0.70 (95% CI 0.56-0.80; I2 = 36%) and the pooled specificity was 0.94 (95% CI 0.89-0.97; I2 = 0%). Qualitative evidence from seven additional studies demonstrated diaphragmatic injury rates of 23%-54% and high feasibility of therapeutic laparoscopy. CONCLUSIONS: CT has high specificity but insufficient sensitivity to reliably exclude diaphragmatic injury after left thoracoabdominal penetrating trauma. Diagnostic laparoscopy remains the reference standard for definitive exclusion and permits immediate repair. TRIAL REGISTRATION: CRD420261458138.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.