title: "Occult" rib fractures diagnosed on computed tomography scan only are still a risk factor for solid organ injury.
abstract: BACKGROUND
  Prior to the widespread use of computed tomography (CT) scan imaging, lower rib fractures diagnosed on chest X-rays (CXRs) were considered a risk factor for abdominal solid organ injury (ASOI). However, CXRs miss about 50% of the rib fractures that are detected on CT scans. We hypothesized that these "occult" rib fractures would not be predictive for ASOI.
  
  
  METHODS
  Retrospective review of a level I trauma center's database identified all adult blunt trauma patients (n = 11,170) over a 5-year period. Data were abstracted for demographics, injury severity score, presence of ASOI, extremity, pelvic and spine fractures as well as presence and location of rib fractures.
  
  
  RESULTS
  Rib fractures correlated with the presence of ASOI, regardless of whether they were diagnosed by CXR or CT scan alone (P < 0.01). Middle (3-7) and lower (8-12) rib fractures, especially, correlated with the presence of ipsilateral ASOI (P < 0.0001).
  
  
  CONCLUSIONS
  Although CT scan detects more rib fractures than CXR, rib fractures remain a marker for increased likelihood of ASOI regardless of the modality by which they are diagnosed. Patients with rib fractures also have a greater incidence of spine and pelvic fractures. As the trauma community debates moving away from routine whole-body CT imaging towards a more selective approach, these results suggest that any clinical suspicion of rib fractures, despite a negative CXR, may warrant further investigation.
authors.affiliation: Department of Surgery, Yale School of Medicine, Connecticut, USA.
authors.forename: Bishwajit
authors.initials: B
authors.lastname: Bhattacharya
authors.affiliation: Department of Surgery, Yale School of Medicine, Connecticut, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Fieber
authors.affiliation: Department of Surgery, Yale School of Medicine, Connecticut, USA.
authors.forename: Kevin
authors.initials: K
authors.lastname: Schuster
authors.affiliation: Department of Surgery, Yale School of Medicine, Connecticut, USA.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Davis
authors.affiliation: Department of Surgery, Yale School of Medicine, Connecticut, USA.
authors.forename: Adrian
authors.initials: A
authors.lastname: Maung
keywords: Computed tomography; liver; rib fracture; solid organ injury; spleen; trauma; whole-body scan