Zhang Liang, McMahon Colm J, Shah Samir, Wu Jim S, Eisenberg Ronald L, Kung Justin W
Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA.
Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA; Harvard Medical School, Boston, MA.
Curr Probl Diagn Radiol. 2018 Mar-Apr;47(2):94-97. doi: 10.1067/j.cpradiol.2017.05.011. Epub 2017 May 30.
To identify the clinical and radiologic predictive factors of rib fractures in stable adult outpatients presenting with chest pain and to determine the utility of dedicated rib radiographs in this population of patients.
Following Institutional Review Board approval, we performed a retrospective review of 339 consecutive cases in which a frontal chest radiograph and dedicated rib series had been obtained for chest pain in the outpatient setting. The frontal chest radiograph and dedicated rib series were sequentially reviewed in consensus by two fellowship-trained musculoskeletal radiologists blinded to the initial report. The consensus interpretation of the dedicated rib series was used as the gold standard. Multiple variable logistic regression analysis assessed clinical and radiological factors associated with rib fractures. Fisher exact test was used to assess differences in medical treatment between the 2 groups.
Of the 339 patients, 53 (15.6%) had at least 1 rib fracture. Only 20 of the 53 (37.7%) patients' fractures could be identified on the frontal chest radiograph. The frontal chest radiograph had a sensitivity of 38% and specificity of 100% when using the rib series as the reference standard. No pneumothorax, new mediastinal widening or pulmonary contusion was identified. Multiple variable logistic regression analysis of clinical factors associated with the presence of rib fractures revealed a significant association of trauma history (odds ratio 5.7 [p < 0.05]) and age ≥40 (odds radio 3.1 [p < 0.05]). Multiple variable logistic regression analysis of radiographic factors associated with rib fractures in this population demonstrated a significant association of pleural effusion with rib fractures (odds ratio 18.9 [p < 0.05]). Patients with rib fractures received narcotic analgesia in 47.2% of the cases, significantly more than those without rib fractures (21.3%, p < 0.05). None of the patients required hospitalization.
In the stable outpatient setting, rib fractures have a higher association with a history of minor trauma and age ≥40 in the adult population. Radiographic findings associated with rib fractures include pleural effusion. The frontal chest radiograph alone has low sensitivity in detecting rib fractures. The dedicated rib series detected a greater number of rib fractures. Although no patients required hospitalization, those with rib fractures were more likely to receive narcotic analgesia.
确定因胸痛就诊的稳定成年门诊患者肋骨骨折的临床和放射学预测因素，并确定专用肋骨X线片在这类患者中的应用价值。
经机构审查委员会批准，我们对339例连续病例进行了回顾性研究，这些病例均在门诊因胸痛拍摄了胸部正位X线片和专用肋骨系列片。两名接受过肌肉骨骼放射学专科培训且对初始报告不知情的放射科医生对胸部正位X线片和专用肋骨系列片进行了先后的一致性阅片。将专用肋骨系列片的一致性解读结果作为金标准。多变量逻辑回归分析评估与肋骨骨折相关的临床和放射学因素。采用Fisher精确检验评估两组之间在治疗方面的差异。
在339例患者中，53例（15.6%）至少有一处肋骨骨折。在这53例骨折患者中，只有20例（37.7%）的骨折能在胸部正位X线片上被识别。以肋骨系列片作为参考标准时，胸部正位X线片的敏感性为38%，特异性为100%。未发现气胸、新的纵隔增宽或肺挫伤。对与肋骨骨折存在相关的临床因素进行多变量逻辑回归分析显示，外伤史（比值比5.7 [p < 0.05]）和年龄≥40岁（比值比3.1 [p < 0.05]）与肋骨骨折有显著相关性。对该人群中与肋骨骨折相关的放射学因素进行多变量逻辑回归分析表明，胸腔积液与肋骨骨折有显著相关性（比值比18.9 [p < 0.05]）。肋骨骨折患者中有47.2%的病例接受了麻醉镇痛治疗，显著多于无肋骨骨折的患者（21.3%，p < 0.05）。所有患者均无需住院治疗。
在稳定的门诊环境中，成年人群中肋骨骨折与轻微外伤史及年龄≥40岁的关联性更高。与肋骨骨折相关的放射学表现包括胸腔积液。仅胸部正位X线片在检测肋骨骨折方面敏感性较低。专用肋骨系列片能检测出更多的肋骨骨折。尽管没有患者需要住院治疗，但肋骨骨折患者更有可能接受麻醉镇痛治疗。
