Diagnostic Accuracy of Computed Tomography Versus Diagnostic Laparoscopy for Detecting Diaphragmatic Injury in Left Thoracoabdominal Penetrating Trauma: A Systematic Review and Meta‐Analysis

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; I 2 = 36%) and the pooled specificity was 0.94 (95% CI 0.89–0.97; I 2 = 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.