title: ACR Appropriateness Criteria® rib fractures.
abstract: Rib fracture is the most common thoracic injury, present in 10% of all traumatic injuries and almost 40% of patients who sustain severe nonpenetrating trauma. Although rib fractures can produce significant morbidity, the diagnosis of associated complications (such as pneumothorax, hemothorax, pulmonary contusion, atelectasis, flail chest, cardiovascular injury, and injuries to solid and hollow abdominal organs) may have a more significant clinical impact. When isolated, rib fractures have a relatively low morbidity and mortality, and failure to detect isolated rib fractures does not necessarily alter patient management or outcome in uncomplicated cases. A standard posteroanterior chest radiograph should be the initial, and often the only, imaging test required in patients with suspected rib fracture after minor trauma. Detailed radiographs of the ribs rarely add additional information that would change treatment, and, although other imaging tests (eg, computed tomography, bone scan) have increased sensitivity for detection of rib fractures, there are little data to support their use. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review process include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
authors.affiliation: *Emory University Hospital, Atlanta, GA †Cleveland Clinic, Weston ‡‡Mayo Clinic, Jacksonville §§§University of Florida College of Medicine, Gainesville, FL ‡Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI §National Jewish Health, Denver, CO ∥Vanderbilt University Medical Center, Nashville, TN ¶Department of Surgery, Society of Thoracic Surgeons, Columbia University, New York ##The American College of Chest Physicians, New York Methodist Hospital, Brooklyn ***North Shore University Hospital, Manhasset, NY #Department of Radiology, Indiana University, Indianapolis, IN **Department of Radiology, University of Michigan Medical Center, Ann Arbor, MI ††Department of Radiology, University of New Mexico, Albuquerque, NM §§Department of Radiology, Society of Nuclear Medicine and Molecular Imaging, Beth Israel Deaconess Medical Center, Boston, MA ∥∥Department of Radiology, Medical University of South Carolina, Charleston, SC ¶¶Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, TX †††Temple University, Philadelphia, PA ‡‡‡Ronald Regan UCLA Medical Center, Los Angeles, CA.
authors.forename: Travis S
authors.initials: TS
authors.lastname: Henry
authors.forename: Jacobo
authors.initials: J
authors.lastname: Kirsch
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Kanne
authors.forename: Jonathan H
authors.initials: JH
authors.lastname: Chung
authors.forename: Edwin F
authors.initials: EF
authors.lastname: Donnelly
authors.forename: Mark E
authors.initials: ME
authors.lastname: Ginsburg
authors.forename: Darel E
authors.initials: DE
authors.lastname: Heitkamp
authors.forename: Ella A
authors.initials: EA
authors.lastname: Kazerooni
authors.forename: Loren H
authors.initials: LH
authors.lastname: Ketai
authors.forename: Barbara L
authors.initials: BL
authors.lastname: McComb
authors.forename: J Anthony
authors.initials: JA
authors.lastname: Parker
authors.forename: James G
authors.initials: JG
authors.lastname: Ravenel
authors.forename: Carlos Santiago
authors.initials: CS
authors.lastname: Restrepo
authors.forename: Anthony G
authors.initials: AG
authors.lastname: Saleh
authors.forename: Rakesh D
authors.initials: RD
authors.lastname: Shah
authors.forename: Robert M
authors.initials: RM
authors.lastname: Steiner
authors.forename: Robert D
authors.initials: RD
authors.lastname: Suh
authors.forename: Tan-Lucien H
authors.initials: TL
authors.lastname: Mohammed
mesh_terms: D003952:Diagnostic Imaging / Q000379:methods*; D006801:Humans; D011871:Radiology / Q000592:standards; D012253:Rib Fractures / Q000175:diagnosis* / Q000209:etiology; D013898:Thoracic Injuries / Q000150:complications / Q000175:diagnosis