Rib fractures and their association With solid organ injury: higher rib fractures have greater significance for solid organ injury screening.
BACKGROUND
The purpose of this study was to identify patients with rib injuries who were at risk for solid organ injury.


METHODS
A retrospective chart review was performed of all blunt trauma patients with rib fractures during the period from July 2007 to July 2012. Data were analyzed for association of rib fractures and solid organ injury.


RESULTS
In all, 1,103 rib fracture patients were identified; 142 patients had liver injuries with 109 (77%) associated right rib fractures. Right-sided rib fractures with highest sensitivity for liver injury were middle rib segment (5 to 8) and lower segment (9 to 12) with liver injury sensitivities of 68% and 43%, respectively (P < .001); 151 patients had spleen injuries with 119 (79%) associated left rib fractures. Left middle segment rib fractures and lower segment rib fractures had sensitivities of 80% and 63% for splenic injury, respectively (P < .003).


CONCLUSIONS
Rib fractures higher in the thoracic cage have significant association with solid organ injury. Using rib fractures from middle plus lower segments as indication for abdominal screening will significantly improve rib fracture sensitivity for identification of solid organ injury.
Division of Trauma and Surgical Critical Care, Department of Surgery, University of South Alabama, Mobile, AL, USA.
Jack W
JW
Rostas
Division of Trauma and Surgical Critical Care, Department of Surgery, University of South Alabama, Mobile, AL, USA.
Timothy B
TB
Lively
Division of Trauma and Surgical Critical Care, Department of Surgery, University of South Alabama, Mobile, AL, USA.
Sidney B
SB
Brevard
Division of Trauma and Surgical Critical Care, Department of Surgery, University of South Alabama, Mobile, AL, USA.
Jon D
JD
Simmons
Division of Trauma and Surgical Critical Care, Department of Surgery, Texas Presbyterian Health Medical Center, Dallas, TX, USA.
Mohammad A
MA
Frotan
Division of Trauma and Surgical Critical Care, Department of Surgery, Loyola University Medical Center, 2160 S. First Ave., Maywood, IL 60153, USA. Electronic address: richard.gonzalez@lumc.edu.
Richard P
RP
Gonzalez
D000407:Alabama / Q000453:epidemiology; D005260:Female; D006801:Humans; D007668:Kidney / Q000000981:diagnostic imaging / Q000293:injuries*; D008099:Liver / Q000000981:diagnostic imaging / Q000293:injuries*; D008297:Male; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012253:Rib Fractures / Q000000981:diagnostic imaging / Q000453:epidemiology*; D012680:Sensitivity and Specificity; D013154:Spleen / Q000000981:diagnostic imaging / Q000293:injuries*
Abdominal screening; Liver injury; Renal injury; Rib fractures; Solid organ injury; Spleen injury