Murphy Charles E, Raja Ali S, Baumann Brigitte M, Medak Anthony J, Langdorf Mark I, Nishijima Daniel K, Hendey Gregory W, Mower William R, Rodriguez Robert M
Department of Emergency Medicine, University of California-San Francisco, San Francisco, CA.
Department of Emergency Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, MA.
Ann Emerg Med. 2017 Dec;70(6):904-909. doi: 10.1016/j.annemergmed.2017.04.011. Epub 2017 May 27.
With increased use of chest computed tomography (CT) in trauma evaluation, traditional teachings in regard to rib fracture morbidity and mortality may no longer be accurate. We seek to determine rates of rib fracture observed on chest CT only; admission and mortality of patients with isolated rib fractures, rib fractures observed on CT only, and first or second rib fractures; and first or second rib fracture-associated great vessel injury.
We conducted a planned secondary analysis of 2 prospectively enrolled cohorts of the National Emergency X-Radiography Utilization Study chest studies, which evaluated patients with blunt trauma who were older than 14 years and received chest imaging in the emergency department. We defined rib fractures and other thoracic injuries according to CT reports and followed patients through their hospital course to determine outcomes.
Of 8,661 patients who had both chest radiograph and chest CT, 2,071 (23.9%) had rib fractures, and rib fractures were observed on chest CT only in 1,368 cases (66.1%). Rib fracture patients had higher admission rates (88.7% versus 45.8%; mean difference 42.9%; 95% confidence interval [CI] 41.4% to 44.4%) and mortality (5.6% versus 2.7%; mean difference 2.9%; 95% CI 1.8% to 4.0%) than patients without rib fracture. The mortality of patients with rib fracture observed on chest CT only was not statistically significantly different from that of patients with fractures also observed on chest radiograph (4.8% versus 5.7%; mean difference -0.9%; 95% CI -3.1% to 1.1%). Patients with first or second rib fractures had significantly higher mortality (7.4% versus 4.1%; mean difference 3.3%; 95% CI 0.2% to 7.1%) and prevalence of concomitant great vessel injury (2.8% versus 0.6%; mean difference 2.2%; 95% CI 0.6% to 4.9%) than patients with fractures of ribs 3 to 12, and the odds ratio of great vessel injury with first or second rib fracture was 4.4 (95% CI 1.8 to 10.4).
Under trauma imaging protocols that commonly incorporate chest CT, two thirds of rib fractures were observed on chest CT only. Patients with rib fractures had higher admission rates and mortality than those without rib fractures. First or second rib fractures were associated with significantly higher mortality and great vessel injury.
随着胸部计算机断层扫描（CT）在创伤评估中的应用增加，关于肋骨骨折发病率和死亡率的传统观点可能不再准确。我们旨在确定仅在胸部CT上观察到的肋骨骨折发生率；孤立性肋骨骨折、仅在CT上观察到的肋骨骨折以及第一或第二肋骨骨折患者的入院率和死亡率；以及第一或第二肋骨骨折相关的大血管损伤情况。
我们对国家急诊X线摄影利用研究胸部研究的2个前瞻性入组队列进行了计划中的二次分析，该研究评估了年龄大于14岁且在急诊科接受胸部影像学检查的钝性创伤患者。我们根据CT报告定义肋骨骨折和其他胸部损伤，并跟踪患者的住院过程以确定结局。
在8661例同时进行了胸部X线片和胸部CT检查的患者中，2071例（23.9%）有肋骨骨折，其中仅在胸部CT上观察到肋骨骨折的有1368例（66.1%）。肋骨骨折患者的入院率（88.7%对45.8%；平均差异42.9%；95%置信区间[CI]41.4%至44.4%）和死亡率（5.6%对2.7%；平均差异2.9%；95%CI1.8%至4.0%）高于无肋骨骨折的患者。仅在胸部CT上观察到肋骨骨折的患者的死亡率与胸部X线片上也观察到骨折的患者的死亡率无统计学显著差异（4.8%对5.7%；平均差异-0.9%；95%CI-3.1%至1.1%）。第一或第二肋骨骨折的患者的死亡率（7.4%对4.1%；平均差异3.3%；95%CI0.2%至7.1%）和合并大血管损伤的患病率（2.8%对0.6%；平均差异2.2%；95%CI0.6%至4.9%）显著高于第3至12肋骨骨折的患者，第一或第二肋骨骨折合并大血管损伤的比值比为4.4（95%CI1.8至10.4）。
在通常包含胸部CT的创伤影像学检查方案下，三分之二的肋骨骨折仅在胸部CT上观察到。肋骨骨折患者的入院率和死亡率高于无肋骨骨折的患者。第一或第二肋骨骨折与显著更高的死亡率和大血管损伤相关。
