Role of Bedside Sonography in Detecting Rib Fractures and Related Injuries
Eurasian Journal of Emergency Medicine
Introduction About 40% of patients with trauma experience chest related injuries. External forces including motor vehicle collisions and falling from height, considered as the most common causes of the blunt trauma (1,2). Rib fracture remains the most frequent finding in chest trauma and occurs because of the blunt trauma in almost half of the cases (3). Rib fractures happen while direct force applied to the sternum caused by a motor vehicle. Aging increases likelihood of rib fractures. Higher
... fractures. Higher thoracic flexibility of children reduces the risk of fracture (1-3). Due to semi-protected position of the upper ribs (1 st to 3 rd ) and limited range of motion of the lower ribs (9 th to 12 th ), these ribs are less vulnerable to the trauma. Therefore, 4 th to 9 th ribs fracture more frequently. However, upper rib fractures, accompany higher mortality rate due to comorbid subclavian artery or vein injuries; and lower rib fractures can increase three and four times the rupture probability of the liver and spleen, respectively (4-7). The more the ribs fracture, the higher the comorbidities occur. Patients with three or more fractured ribs require hospitalization for pain alleviation and further investigations (8,9). Abstract Aim: About 40% of patients with trauma, experience chest related injuries. Rib fracture remains the most frequent finding in chest trauma. Some literatures have suggested chest wall ultrasonography as a potential replacement for chest X-ray (CXR) in detecting rib fractures. The aim of this study is to assess sensitivity and specificity of bedside ultrasonography in detecting rib fractures and related injuries. Materials and Methods: Patients between April 2012 and April 2014 were enrolled in our prospective cross-sectional study. Then emergency medicine specialists performed a bedside ultrasonography to detect any probable fracture and suspected injuries. We took CXRs and an expert radiologist looked for fracture and related injuries. A chest computerized tomography scan was taken and compared with findings of CXR and ultrasonography. Results: Out of 360 patients, 238 met our inclusion criteria and enrolled in the study; where 222 (93.3%) were male and 16 (6.7%) were female with the average age of 33.78±11.62 (± standard deviation). The sensitivity and specificity of two modalities in detecting fracture, pneumothorax, hemothorax and contusion were analyzed. Conclusion: Our study showed that bedside ultrasonography could substitute CXR in detecting not only rib fractures but also related comorbidities especially in minor trauma.