Byline: Patricia J. Bartzak, Society of Trauma Nurses, Frankfort, Kentucky. Abstract OBJECTIVE: To provide a concise review of the literature on both the difficulty and subtly of identifying a traumatic diaphragmatic hernia in the delayed phase of injury. DATA SOURCES: Source data were obtained from PubMed and Open Access Journals. STUDY SELECTION: Studies addressing traumatic diaphragmatic injury in the delayed phase of diaphragmatic injury. PubMed was searched using the MeSH term "delayed diaphragmatic rupture." DATA EXTRACTION: Relevant studies were reviewed and included on the basis of the preponderance of diaphragmatic injury cases that presented in the delayed phase. The following aspects of each study were identified, abstracted, and analyzed: study population, study design, methods, results, and relevant implications for practice. A few case studies were included to illustrate the importance of a careful medical history and patient evaluation necessary to identify a delayed diaphragmatic hernia presentation. DATA SYNTHESIS: Diaphragmatic herniation can occur days and weeks to decades after the initial trauma as a small diaphragmatic tear can evolve into a larger one over time. Follow-up after the acute phase is essential to assess for occult diaphragmatic injury and potential herniation. Meticulous patient history and evaluation are important considerations when the patient presents after the acute phase of injury with vague respiratory or abdominal complaints. During the triage phase of care, trauma nurses have an important role in assessing trauma history. CONCLUSIONS: The available evidence suggests that diaphragmatic injury should be on the differential list during and after trauma presentation for both providers and trauma nurses. Other critical injuries may portend a possible diaphragmatic injury. Diaphragmatic injury, though relatively rare, has high morbidity and mortality.