Jeroukhimov Igor, Hershkovitz Yehuda, Wiser Itay, Kessel Boris, Ayyad Mohammed, Gatot Inbar, Shapira Zahar, Jeoravlev Svetlana, Halevy Ariel, Lavy Ron
Division of Surgery, Assaf Harofeh Medical Center, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Zerifin, Israel.
Department of Plastic Surgery, Assaf Harofeh Medical Center, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Zerifin, Israel.
J Emerg Med. 2017 May;52(5):609-614. doi: 10.1016/j.jemermed.2016.11.007. Epub 2016 Dec 12.
Lower rib fractures are considered as a marker of intra-abdominal organ injury. Abdominal computed tomography (CT) is the "gold standard" examination for patients with lower rib fractures. However, the reported incidence of concomitant intra-abdominal injuries (IAI) is 20%-40%.
The purpose of this study was to evaluate the incidence of intra-abdominal organ injuries in blunt trauma patients with lower rib fractures.
Medical charts and radiology reports of patients with lower rib (from the 8th to 12th rib) fractures admitted to our center during a 6-year period were retrospectively reviewed. Patients were divided into two groups. Group I included patients with intra-abdominal injury (IAI) diagnosed either by CT or on urgent laparotomy, and Group II included those with normal abdominal CT scans. Data included demographics, mechanism of injury, laboratory tests, radiology results including number and location of fractured ribs, and incidence of IAI.
Overall 318 patients were included in the study. Fifty-seven patients (17.9%) had 71 IAIs compared with 265 (82.1%) patients with no IAI. Logistic regression identified age younger than 55 years (relative risk [RR] = 7.2; 95% confidence interval [CI] 3.1-16.8; p = 0.001), bilateral rib fractures (RR = 3.9; 95% CI 1.1-13.5; p = 0.03) and decreased levels of hematocrit (RR = 2.4; 95% CI 1.2-4.8; p = 0.016) as independent risk factors for the presence of IAI.
Abdominal CT should be considered in blunt trauma patients with lower rib fractures who are younger than 55 years of age and have bilateral rib fractures and decreased levels of hematocrit on admission.
下肋骨骨折被视为腹腔内器官损伤的一个标志。腹部计算机断层扫描（CT）是下肋骨骨折患者的“金标准”检查。然而，报道的腹腔内合并伤（IAI）发生率为20% - 40%。
本研究的目的是评估钝性创伤致下肋骨骨折患者腹腔内器官损伤的发生率。
回顾性分析本中心6年间收治的下肋骨（第8至12肋）骨折患者的病历和放射学报告。患者分为两组。第一组包括经CT或急诊剖腹探查诊断为腹腔内损伤（IAI）的患者，第二组包括腹部CT扫描正常的患者。数据包括人口统计学资料、损伤机制、实验室检查、放射学结果（包括肋骨骨折的数量和位置）以及IAI的发生率。
本研究共纳入318例患者。57例患者（17.9%）发生71例IAI，265例患者（82.1%）未发生IAI。逻辑回归分析确定年龄小于55岁（相对危险度[RR]=7.2；95%置信区间[CI] 3.1 - 16.8；p = 0.001）、双侧肋骨骨折（RR = 3.9；95% CI 1.1 - 13.5；p = 0.03）和血细胞比容水平降低（RR = 2.4；95% CI 1.2 - 4.8；p = 0.016）是IAI存在的独立危险因素。
对于年龄小于55岁、有双侧肋骨骨折且入院时血细胞比容水平降低的钝性创伤致下肋骨骨折患者，应考虑进行腹部CT检查。
