Characteristics of rib fracture patients who require chest computed tomography in the emergency department

Characteristics of rib fracture patients who require chest computed tomography in the emergency department

Rib fracture, Chest computed tomography, Intra-thoracic and intra-abdominal injuries, Emergency
department

Background The disadvantages and complications of computed tomography (CT) can be minimized if CT is performed in rib fracture patients with high probability of intra-thoracic and intra-abdominal injuries and CT is omitted
in rib fracture patients with low probability of intra-thoracic and intra-abdominal injuries. This study aimed to evaluate
the factors that can identify patients with rib fractures with intra-thoracic and intra-abdominal injuries in the emergency department among patients with rib fracture.
Methods This retrospective observational study included adult patients (age≥18 years) diagnosed with rib fracture
on chest radiography prior to chest CT due to blunt chest trauma in the emergency department who underwent
chest CT from January 2016 to February 2021. The primary outcomes were intra-thoracic and intra-abdominal injuries
that could be identifed on a chest CT. Multivariate logistic regression analysis was performed.
Results Among the characteristics of rib fractures, the number of rib fractures was greater (5.0 [3.0–7.0] vs. 2.0
[1.0–3.0], p<0.001), bilateral rib fractures were frequent (56 [20.1%] vs. 12 [9.8%], p=0.018), and lateral and posterior
rib fracture was more frequent (lateral rib fracture: 160 [57.3%] vs. 25 [20.5%], p<0.001; posterior rib fracture: 129
[46.2%] vs. 21 [17.2%], p<0.001), and displacement was more frequent (99 [35.5%] vs. 6 [6.6%], p<0.001) in the group
with intra-thoracic and intra-abdominal injuries than in the group with no injury. The number of rib fractures (adjusted
odds ratio [aOR], 1.44; 95% confdence interval [CI], 1.16–1.78; p=0.001), lateral rib fracture (aOR, 2.80; 95% CI, 1.32–
5.95; p=0.008), and posterior rib fracture (aOR, 3.18; 95% CI, 1.45–6.94; p=0.004) were independently associated with
intra-thoracic and intra-abdominal injuries. The optimal cut-of for the number of rib fractures on the outcome was
three. The number of rib fractures≥3 (aOR, 3.01; 95% CI, 1.35–6.71; p=0.007) was independently associated with
intra-thoracic and intra-abdominal injuries.
Conclusion In patients with rib fractures due to blunt trauma, those with lateral or posterior rib fractures, those
with≥3 rib fractures, and those requiring O2 supplementation require chest CT to identify signifcant intra-thoracic
and intra-abdominal injuries in the emergency department.

Woosik Kim, Juhyun Song, Sungwoo Moon, Jooyeong Kim, Hanjin Cho, Jonghak Park, Sungjin Kim and Sejoong Ahn*

BMC Emergency Medicine

(2023) 23:33

Fajar bagus W

PDF

English

Text