From the Department of Emergency Medicine (J.M.S., L.A.B., L.S.C., G.J.L., S.P.T., N.I.S., C.L.R.), and Department of Radiology (R.B.L.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
J Trauma Acute Care Surg. 2019 May;86(5):838-843. doi: 10.1097/TA.0000000000002208.
Previous studies demonstrate an association between rib fractures and morbidity and mortality in trauma. This relationship in low-mechanism injuries, such as ground-level fall, is less clearly defined. Furthermore, computed tomography (CT) has increased sensitivity for rib fractures compared with chest x-ray (CXR); its utility in elderly fall patients is unknown. We sought to determine whether CT-diagnosed rib fractures in elderly fall patients with a normal CXR were associated with increased in-hospital resource utilization or mortality.
Retrospective analysis of emergency department patients presenting over a 3-year period.
age, 65 years or older; chief complaint, including mechanical fall; and both CXR and CT obtained. We quantified rib fractures on CXR and CT and reported operating characteristics for both. Outcomes of interest included hospital admission/length of stay (LOS), intensive care unit (ICU) admission/LOS, endotracheal intubation, tube thoracostomy, locoregional anesthesia, pneumonia, in-hospital mortality.
We identified 330 patients, mean age was 84 years (±SD, 9.4 years); 269 (82%) of 330 were admitted. There were 96 (29%) patients with CT-diagnosed rib fracture, 56 (17%) by CT only. Compared with CT, CXR had a sensitivity of 40% (95% confidence interval, 30-50%) and specificity of 99% (95% confidence interval, 97-100%) for rib fracture. A median of two additional radiographically occult rib fractures were identified on CT. Despite an increased hospital admission rate (91% vs. 78%) p = 0.02, there was no difference between patients with and without radiographically occult (CT+ CXR-) rib fracture(s) for: median LOS (4; interquartile range (IQR) 2-7 vs 4, IQR 2-8); p = 0.92), ICU admission (28% vs. 27%) p = 0.62, median ICU LOS (2, IQR 1-8 vs 3, IQR 1-5) p = 0.54, or in-hospital mortality (10.3% vs. 7.3%) p = 0.45.
Among elderly fall patients, CT-identified rib fractures were associated with increased hospital admissions. However, there was no difference in procedural interventions, ICU admission, hospital/ICU LOS or mortality for patients with and without radiographically occult fractures.
Diagnostic, level III.
先前的研究表明，肋骨骨折与创伤患者的发病率和死亡率之间存在关联。在地面水平跌倒等低机制损伤中，这种关系的定义不太明确。此外，与胸部 X 射线（CXR）相比，计算机断层扫描（CT）对肋骨骨折的敏感性更高；但其在老年跌倒患者中的应用尚不清楚。我们试图确定在 CXR 正常的老年跌倒患者中，CT 诊断的肋骨骨折是否与住院期间资源利用增加或死亡率增加有关。
对 3 年来急诊科患者进行回顾性分析。
年龄，65 岁或以上；主诉，包括机械性跌倒；并同时进行 CXR 和 CT 检查。我们在 CXR 和 CT 上量化了肋骨骨折，并报告了两者的操作特征。感兴趣的结果包括住院/住院时间（LOS）、重症监护病房（ICU）入院/LOS、气管插管、胸腔引流、局部区域麻醉、肺炎、院内死亡率。
我们确定了 330 名患者，平均年龄为 84 岁（±标准差，9.4 岁）；330 名患者中有 269 名（82%）入院。96 名（29%）患者 CT 诊断为肋骨骨折，56 名（17%）仅 CT 诊断。与 CT 相比，CXR 对肋骨骨折的敏感性为 40%（95%置信区间，30-50%），特异性为 99%（95%置信区间，97-100%）。在 CT 上还发现了中位数为 2 处额外的放射学隐匿性肋骨骨折。尽管住院率（91%对 78%）增加（p = 0.02），但影像学隐匿性（CT+CXR-）肋骨骨折患者的中位 LOS（4；四分位距（IQR）2-7 对 4，IQR 2-8）（p = 0.92）、ICU 入院率（28%对 27%）（p = 0.62）、ICU 中位 LOS（2，IQR 1-8 对 3，IQR 1-5）（p = 0.54）或院内死亡率（10.3%对 7.3%）（p = 0.45）之间没有差异。
在老年跌倒患者中，CT 识别的肋骨骨折与住院人数增加有关。然而，影像学隐匿性骨折患者与非影像学隐匿性骨折患者在手术干预、ICU 入院、住院/ICU LOS 或死亡率方面无差异。
诊断，III 级。
