{"schema":"https://ver.cy/schemas/card/1.0.0","id":"vr.tr.diaphragmatic-rupture","code":"thing-q243877","url":"https://ver.cy/models/thing/q243877/","name":"diaphragmatic rupture","alternateNames":[],"kind":"thing","status":"published","version":"0.1.0-research.1","language":"en","classifiers":{"family":"Thing Registry","category":"Activities and processes","entryKind":"thing","plane":"ACT","domain":["ACT.ACT"],"industry":[],"navPath":"","tags":[],"facets":{}},"whatItIs":"Diaphragmatic rupture is an acquired full-thickness tear of the diaphragm, usually caused by blunt or penetrating trauma, that can permit abdominal organs to herniate into the thoracic cavity.","purpose":"Enable an agent to recognise a suspected or confirmed diaphragmatic rupture, record its anatomical and physiological consequences, and support clinician-led investigation, treatment and follow-up.","scope":{"in":["Suspected or confirmed acquired diaphragm tears and their supporting evidence","Defect location, extent, tissue condition and mechanism","Presence or absence of abdominal viscera passing through the defect","Respiratory compromise and threatened herniated organs attributable to the rupture","Rupture-specific management decisions, repair integrity and delayed complications"],"out":["Congenital diaphragmatic defects without an acquired tear","Diaphragmatic eventration or paralysis without structural discontinuity","Hiatal hernia without evidence of acquired diaphragm rupture","Comprehensive management of associated thoracic and abdominal injuries","General ventilatory support protocols and operative technique manuals"],"boundaries":[]},"distinguishingFeatures":["An acquired discontinuity distinguishes rupture from an intact but elevated, weakened or paralysed diaphragm.","Rupture describes the structural defect; herniation describes organ passage through it, so visible herniation is not required to represent a rupture.","A history of trauma supports an acquired mechanism but does not independently establish a diaphragm tear.","A suspected tear remains distinct from a confirmed tear when imaging or direct inspection is inconclusive.","A defect outside a normal anatomical opening must be distinguished from organ passage through an enlarged oesophageal hiatus."],"structure":{"bundles":[{"id":"acquired-defect-identity","name":"Acquired defect identity","description":"Establish what structural lesion is being represented and how it arose.","layers":[{"id":"structural-boundary","name":"Structural boundary","description":"Separate acquired tissue disruption from neighbouring diaphragm disorders.","findings":[{"id":"continuity-disruption","name":"Continuity disruption","description":"Record whether a tear is demonstrated, inferred or unresolved, including evidence against congenital defects, eventration and isolated hiatal disease.","questions":[{"text":"What observation establishes an acquired break in diaphragm continuity?","id":"continuity-disruption-q01","kind":"definition"},{"text":"Could the finding instead represent an intact elevated diaphragm, a congenital defect or an enlarged normal hiatus?","id":"continuity-disruption-q02","kind":"boundary"}]}]},{"id":"mechanism-and-chronology","name":"Mechanism and chronology","description":"Connect the lesion to an injury event without conflating recognition time with onset.","findings":[{"id":"injury-recognition-sequence","name":"Injury and recognition sequence","description":"Maintain separate dates and confidence for the causative event, first symptoms, first suspicious evidence and confirmation.","questions":[{"text":"Which documented event or procedure is linked to the tear, and how certain is that attribution?","id":"injury-recognition-sequence-q01","kind":"provenance"},{"text":"What interval separates the suspected injury from recognition, and which dates are estimates?","id":"injury-recognition-sequence-q02","kind":"measurement"}]}]}]},{"id":"defect-and-visceral-consequences","name":"Defect and visceral consequences","description":"Describe the physical opening and what has happened to adjacent organs.","layers":[{"id":"tear-anatomy","name":"Tear anatomy","description":"Localise and measure each observed discontinuity.","findings":[{"id":"defect-map","name":"Defect map","description":"Record side, anatomical region, dimensions, number of defects and observed tissue loss, retaining differences between imaging and operative observations.","questions":[{"text":"Where is each tear, and what are its measured dimensions and tissue-loss features?","id":"defect-map-q01","kind":"measurement"},{"text":"Were these details observed on imaging or during an operation, and were any diaphragm regions unassessed?","id":"defect-map-q02","kind":"provenance"}]}]},{"id":"herniation-and-organ-threat","name":"Herniation and organ threat","description":"Represent organ displacement and compromise separately from the tear.","findings":[{"id":"displaced-viscera-status","name":"Displaced viscera status","description":"Identify any contents traversing the defect and separately document evidence of entrapment, obstruction, impaired perfusion or perforation.","questions":[{"text":"Which organs traverse the tear, and is herniation absent, present or indeterminate?","id":"displaced-viscera-status-q01","kind":"measurement"},{"text":"What evidence supports or excludes obstruction, impaired perfusion or perforation of those organs?","id":"displaced-viscera-status-q02","kind":"measurement"}]}]}]},{"id":"diagnostic-confidence-and-clinical-impact","name":"Diagnostic confidence and clinical impact","description":"Maintain the strength of diagnostic evidence and the patient's rupture-related clinical state.","layers":[{"id":"investigation-adequacy","name":"Investigation adequacy","description":"Assess what each examination can establish in the documented injury context.","findings":[{"id":"residual-diagnostic-uncertainty","name":"Residual diagnostic uncertainty","description":"Record examination findings, technical limitations and remaining suspicion. Diagnostic strategy depends on injury context; the EAST guideline specifically evaluates laparoscopy versus CT for stable left thoracoabdominal stab wounds. [EAST guideline](https://www.east.org/education-resources/practice-management-guidelines/details/diaphragmatic-injury-evaluation-and-management-of).","questions":[{"text":"What did each examination demonstrate, and what limited assessment of diaphragm continuity?","id":"residual-diagnostic-uncertainty-q01","kind":"provenance"},{"text":"If suspicion remains, what further assessment has the responsible clinician selected and why?","id":"residual-diagnostic-uncertainty-q02","kind":"action"}]}]},{"id":"physiological-attribution","name":"Physiological attribution","description":"Relate respiratory or circulatory changes to the rupture while retaining competing explanations.","findings":[{"id":"rupture-related-deterioration","name":"Rupture-related deterioration","description":"Link timed physiological observations to possible mechanical or visceral consequences without automatically attributing all trauma-related instability to the diaphragm.","questions":[{"text":"How have oxygenation, ventilation and haemodynamic observations changed alongside the anatomical findings?","id":"rupture-related-deterioration-q01","kind":"measurement"},{"text":"Which effects are attributed to the rupture, and which may arise from associated injuries?","id":"rupture-related-deterioration-q02","kind":"boundary"}]}]}]},{"id":"management-and-repair-course","name":"Management and repair course","description":"Capture the clinical decision, repair record and subsequent integrity of the diaphragm.","layers":[{"id":"management-rationale","name":"Management rationale","description":"Record the chosen pathway, its clinical basis and accountable team.","findings":[{"id":"individualised-management-decision","name":"Individualised management decision","description":"Record how mechanism, side, stability, associated injuries and presentation timing informed management. EAST's recommendations are conditional and supported by very low-quality evidence, so guideline applicability and uncertainty must remain explicit. [EAST guideline](https://www.east.org/education-resources/practice-management-guidelines/details/diaphragmatic-injury-evaluation-and-management-of).","questions":[{"text":"What management did the responsible team choose, and which patient-specific findings and guideline population support it?","id":"individualised-management-decision-q01","kind":"action"},{"text":"If definitive treatment is deferred, what reason, reassessment plan and escalation criteria are documented?","id":"individualised-management-decision-q02","kind":"action"}]}]},{"id":"repair-integrity-and-follow-up","name":"Repair integrity and follow-up","description":"Follow the anatomical and functional outcome after treatment.","findings":[{"id":"closure-and-subsequent-defect-status","name":"Closure and subsequent defect status","description":"Link the operative account of closure and any prosthetic material to subsequent evidence of integrity, residual discontinuity, recurrent herniation and persistent symptoms.","questions":[{"text":"What documents the completed repair, including defect coverage, tissue condition and any implanted material?","id":"closure-and-subsequent-defect-status-q01","kind":"provenance"},{"text":"What follow-up evidence distinguishes intact repair, residual defect and recurrence, and what remains unassessed?","id":"closure-and-subsequent-defect-status-q02","kind":"measurement"}]}]}]},{"id":"evidence-and-external-alignment","name":"Evidence and external alignment","description":"What the world already says about this thing, gathered so the model can be checked against it.","layers":[{"id":"reported-evidence","name":"Reported evidence","description":"Findings from the breadth pass, kept separate from the structural claims.","findings":[{"id":"evidence-confidence-notes","name":"Check these first","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these check these first hold for the sense of diaphragmatic rupture this model covers, and on what evidence?","id":"evidence-confidence-notes-q01","kind":"provenance"}]},{"id":"evidence-kinds","name":"Kinds and varieties","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these kinds and varieties hold for the sense of diaphragmatic rupture this model covers, and on what evidence?","id":"evidence-kinds-q01","kind":"provenance"}]},{"id":"evidence-real-world-use","name":"Real-world use","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these real-world use hold for the sense of diaphragmatic rupture this model covers, and on what evidence?","id":"evidence-real-world-use-q01","kind":"provenance"}]},{"id":"evidence-failure-modes-and-hazards","name":"Failure modes and hazards","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these failure modes and hazards hold for the sense of diaphragmatic rupture this model covers, and on what evidence?","id":"evidence-failure-modes-and-hazards-q01","kind":"provenance"}]},{"id":"evidence-neighbours","name":"Neighbouring kinds and how to tell them apart","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these neighbouring kinds and how to tell them apart hold for the sense of diaphragmatic rupture this model covers, and on what evidence?","id":"evidence-neighbours-q01","kind":"provenance"}]}]}]}]},"agentConduct":{"may":["Explain what diaphragmatic rupture is from medical sources.","Advise anyone with chest or abdominal trauma to seek emergency care."],"mustNot":["Diagnose diaphragmatic rupture in a person.","Advise delaying emergency care after major trauma.","Recommend treatment for a specific patient."],"requiresHuman":["Any diagnosis and treatment, made by clinicians."]},"ethics":{"considerations":["Missed diagnoses after trauma can lead to delayed life-threatening complications.","Patient information about injuries must stay private."],"affectedParties":["Trauma patients","Families","Clinicians"]},"owners":{"steward":"Nobody owns the condition; the treating clinician answers for each patient's care.","roles":[],"masterSystems":[]},"relations":[{"target":"Q18553873","type":"parent","note":"registry parent class"},{"target":"Q368370","type":"parent","note":"registry parent class"}],"interaction":{"identity":{"applicability":"required","items":["Vercy registry: vr.tr.diaphragmatic-rupture","Wikidata: Q243877 (https://www.wikidata.org/wiki/Q243877)"]},"properties":{"applicability":"not-applicable","items":["Diagnostic status: suspected | confirmed | excluded | unresolved","Acquisition mechanism: blunt trauma | penetrating trauma | iatrogenic injury | other documented acquired mechanism | unknown","Defect location: left | right | bilateral | unknown; muscular, central tendon or attachment location where documented","Defect dimensions: length and width in cm, with observation method and date","Injury-to-recognition interval: hours or days; estimated interval or unknown when injury timing is uncertain","Herniated contents: linked organs or tissues, their thoracic position, and absent | present | indeterminate herniation","Visceral compromise: no demonstrated compromise | obstruction suspected or confirmed | ischaemia suspected or confirmed | perforation suspected or confirmed | unknown","Respiratory effect: linked oxygenation, ventilation and respiratory-support observations, with attribution confidence","Repair status: unrepaired | repair planned | repaired | residual defect suspected or confirmed | recurrence suspected or confirmed"]},"recognition":{"applicability":"optional","items":["Not visible from outside; diagnosed by imaging or surgery.","Imaging may show abdominal organs or gas in the chest cavity."]},"capabilities":{"applicability":"required","items":["Organise evidence for and against an acquired diaphragm tear.","Track defect anatomy separately from herniation and organ viability.","Flag documented deterioration or suspected visceral compromise for urgent clinician review.","Identify unresolved diagnostic questions and record clinician-selected investigations.","Link management decisions to the injury pattern, guideline context and responsible clinical team.","Compare follow-up findings with the original defect and repair record."]},"hazards":{"applicability":"required","items":["Herniated organs can become strangulated.","Breathing can be compromised."]},"interfaces":{"applicability":"required","items":["The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, issued by the World Health Organization, provides the injury classification used for coding traumatic diaphragmatic rupture.","The Organ Injury Scale for the diaphragm, issued by the American Association for the Surgery of Trauma, grades anatomical injury severity."]},"context":{"applicability":"required","items":["Diaphragmatic rupture is encountered in trauma assessment, diagnostic imaging and surgical care following blunt or penetrating injury.","It may also be investigated after a delay when previously unrecognised injury produces herniation or respiratory and abdominal symptoms."]}},"sources":[{"title":"Wikidata item Q243877: diaphragmatic rupture","url":"https://www.wikidata.org/wiki/Q243877","note":"identity and sense of the item"},{"title":"Wikipedia: Diaphragmatic rupture","url":"https://en.wikipedia.org/wiki/Diaphragmatic_rupture","note":"general description of the item"}],"openQuestions":["Does this registry entry intentionally include iatrogenic and other non-traumatic acquired tears, or is its intended scope traumatic rupture alone?","Should the ACT / ACT.ACT placement represent the injury event, or should the resulting anatomical condition have a different classification?","Which diagnostic pathways and exclusion criteria are sufficiently supported for each mechanism, side and patient population?","How should differing recommendations for selected right-sided penetrating injuries be reconciled in the applicable clinical setting?","What follow-up duration and assessment strategy best detect delayed herniation or recurrence after repair or selected observation?"],"resources":{"spec":"/models/things/publications/thing-q243877/spec.json"},"provenance":{"origin":"thing registry research (pass 2)","builtFrom":["models/things/publications/thing-q243877/spec.json"],"providers":["Codex"],"researchStatus":"unreviewed","generatedAt":"2026-09-12T09:09:02Z","builder":"tools/build_cards.py@1.0.0"},"completeness":{"sections":{"classifiers":"filled","whatItIs":"filled","purpose":"filled","distinguishingFeatures":"filled","structure":"filled","agentConduct":"filled","ethics":"filled","owners":"filled","relations":"filled","interaction.identity":"filled","interaction.properties":"not-applicable","interaction.recognition":"filled","interaction.capabilities":"filled","interaction.hazards":"filled","interaction.interfaces":"filled","interaction.context":"filled","sources":"filled"},"notes":{"_gate":"Published through the thing publication gate 1.0 on 2026-10-07T10:10:29+00:00: completeness 1.00; sense: Wikidata description; 2 live sources; review by codex: pass","interaction.properties":"Plane ACT: no invented physical properties."},"score":1.0}}