The Diagnostic Accuracy of Ultrasonography for the Diagnosis of Rib Fractures in Patients Presenting to Emergency Department With Blunt Chest Trauma |
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| Authors: | Ali Çelik Haldun Akoglu Serhad Omercikoglu Onur Bugdayci Sinan Karacabey Kerem Ali Kabaroglu Ozge Onur Arzu Denizbasi |
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| Affiliation: | 1. Department of Emergency Medicine, Rize Recep Tayyip Erdogan University Training and Research Hospital, Rize, Turkey;2. Department of Emergency Medicine, Marmara University School of Medicine, Istanbul, Turkey;3. Department of Radiology, Marmara University School of Medicine, Istanbul, Turkey;1. Intensive Care Unit, North District Hospital, Sheung Shui, New Territories, Hong Kong;2. Accident & Emergency Department, North District Hospital, Sheung Shui, New Territories, Hong Kong;1. Harvard Medical Toxicology Program, Boston Children''s Hospital, Boston, Massachusetts;2. Division of Emergency Medicine, Department of Pediatrics, Boston Children''s Hospital, Boston, Massachusetts;3. Division of General Pediatrics, Department of Pediatrics, Boston Children''s Hospital, Boston, Massachusetts;1. University of Maryland School of Medicine, Baltimore, Maryland;2. The Research Associate Program in Emergency Medicine and Critical Care, University of Maryland School of Medicine, Baltimore, Maryland;3. University of Maryland, Baltimore County, Baltimore, Maryland;4. Ocean City Beach Patrol, Ocean City, Maryland;5. Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland;1. Pediatric Emergency and Intensive Care Units, Post Graduate Institute of Medical Education and Research, Chandigarh, India;2. Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India |
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| Abstract: | BackgroundRib fractures are the most common complications of blunt chest trauma (BCT). Computed tomography (CT) is the modality of choice for BCT, but with several disadvantages. Ultrasonography (US) is an inexpensive, readily available, and relatively harmless imaging alternative. However, a direct comparison of the sonographic evaluation of the rib as a whole with CT as a reference has not been performed to date.ObjectiveThis study aimed to compare the diagnostic accuracy of US with CT for the detection of rib fractures in patients who presented to emergency department (ED) with BCT.MethodsWe included a convenience sample of adult patients who presented to the ED with thoracic pain after BCT in the last 24 h in this prospective, observational, diagnostic accuracy study. The diagnostic utility of US performed by an emergency physician was compared with thorax CT.ResultsThe final study population included 145 patients. The diagnostic accuracy of US was 80% with a sensitivity of 91.2% and specificity of 72.7% for the detection of any rib fracture (positive likelihood ratio 3.4 and negative likelihood ratio 0.12). If we considered each rib separately, the sensitivity of US decreased to 76.7% and specificity increased to 82.7% (81.3% accuracy).ConclusionsA negative US of the site of the highest tenderness and neighboring ribs in a patient with BCT who presented to the ED with lateralizing pain decreases the possibility of a rib fracture significantly. However, a positive US performs poorly to specify the exact location and number of the fractured ribs. |
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| Keywords: | ribs emergency ultrasound chest trauma emergency medicine |
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