The significance of first rib fractures in children.
OBJECTIVE
The purpose of the study was to determine if first rib fractures are associated with an increased incidence of thoracic vascular injury in pediatric patients.


METHODS
The medical records of all children diagnosed with a first rib fracture or a central vascular injury after blunt trauma treated at a state-designated level 1 pediatric trauma center from 2000 to 2009 were reviewed.


RESULTS
Thirty-three children (0.27% of patients; mean age, 10.9 ± 0.9 years) were identified with either a first rib fracture or thoracic vascular injury owing to blunt trauma. Thirty-two children had a first rib fracture, and only 1 child (3%) had significant thoracic vascular injury. Mediastinal abnormalities (indistinct aortic knob) were identified in 3 children, 2 with first rib fracture on initial chest radiograph. Despite a normal cardiovascular examination result, 25 (74%) children with a normal mediastinum on screening chest radiograph underwent computed tomography. No child with a normal mediastinum on initial chest radiograph was found to have associated intrathoracic injuries requiring further intervention. In children with first rib fractures and a normal mediastinum by screening chest x-ray, the negative predictive value for thoracic vascular injury was 100%.


CONCLUSIONS
Children with first rib fractures without mediastinal abnormality on chest radiograph require no further workup for thoracic vascular injury.
Division of Pediatric Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
Nicholas A
NA
Hamilton
Brian T
BT
Bucher
Martin S
MS
Keller
D000293:Adolescent; D000367:Age Factors; D002648:Child; D015897:Comorbidity; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008482:Mediastinum / Q000000981:diagnostic imaging; D013902:Radiography, Thoracic; D012253:Rib Fractures / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery; D013895:Thoracic Arteries / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery; D013898:Thoracic Injuries / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers / Q000706:statistics & numerical data; D057772:Vascular System Injuries / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery