title: When Should Abdominal Computed Tomography Be Considered in Patients with Lower Rib Fractures?
abstract: BACKGROUND
  Lower rib fractures are considered as a marker of intra-abdominal organ injury. Abdominal computed tomography (CT) is the "gold standard" examination for patients with lower rib fractures. However, the reported incidence of concomitant intra-abdominal injuries (IAI) is 20%-40%.
  
  
  OBJECTIVE
  The purpose of this study was to evaluate the incidence of intra-abdominal organ injuries in blunt trauma patients with lower rib fractures.
  
  
  METHODS
  Medical charts and radiology reports of patients with lower rib (from the 8th to 12th rib) fractures admitted to our center during a 6-year period were retrospectively reviewed. Patients were divided into two groups. Group I included patients with intra-abdominal injury (IAI) diagnosed either by CT or on urgent laparotomy, and Group II included those with normal abdominal CT scans. Data included demographics, mechanism of injury, laboratory tests, radiology results including number and location of fractured ribs, and incidence of IAI.
  
  
  RESULTS
  Overall 318 patients were included in the study. Fifty-seven patients (17.9%) had 71 IAIs compared with 265 (82.1%) patients with no IAI. Logistic regression identified age younger than 55 years (relative risk [RR] = 7.2; 95% confidence interval [CI] 3.1-16.8; p = 0.001), bilateral rib fractures (RR = 3.9; 95% CI 1.1-13.5; p = 0.03) and decreased levels of hematocrit (RR = 2.4; 95% CI 1.2-4.8; p = 0.016) as independent risk factors for the presence of IAI.
  
  
  CONCLUSIONS
  Abdominal CT should be considered in blunt trauma patients with lower rib fractures who are younger than 55 years of age and have bilateral rib fractures and decreased levels of hematocrit on admission.
authors.affiliation: Division of Surgery, Assaf Harofeh Medical Center, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Zerifin, Israel.
authors.forename: Igor
authors.initials: I
authors.lastname: Jeroukhimov
authors.affiliation: Division of Surgery, Assaf Harofeh Medical Center, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Zerifin, Israel.
authors.forename: Yehuda
authors.initials: Y
authors.lastname: Hershkovitz
authors.affiliation: Department of Plastic Surgery, Assaf Harofeh Medical Center, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Zerifin, Israel.
authors.forename: Itay
authors.initials: I
authors.lastname: Wiser
authors.affiliation: Trauma Unit, Hillel Yaffe Medical Center, Hadera, Israel.
authors.forename: Boris
authors.initials: B
authors.lastname: Kessel
authors.affiliation: Division of Surgery, Assaf Harofeh Medical Center, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Zerifin, Israel.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Ayyad
authors.affiliation: Division of Surgery, Assaf Harofeh Medical Center, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Zerifin, Israel.
authors.forename: Inbar
authors.initials: I
authors.lastname: Gatot
authors.affiliation: Division of Surgery, Assaf Harofeh Medical Center, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Zerifin, Israel.
authors.forename: Zahar
authors.initials: Z
authors.lastname: Shapira
authors.affiliation: Division of Surgery, Assaf Harofeh Medical Center, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Zerifin, Israel.
authors.forename: Svetlana
authors.initials: S
authors.lastname: Jeoravlev
authors.affiliation: Division of Surgery, Assaf Harofeh Medical Center, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Zerifin, Israel.
authors.forename: Ariel
authors.initials: A
authors.lastname: Halevy
authors.affiliation: Division of Surgery, Assaf Harofeh Medical Center, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Zerifin, Israel.
authors.forename: Ron
authors.initials: R
authors.lastname: Lavy
mesh_terms: D000005:Abdomen / Q000503:physiopathology*; D000007:Abdominal Injuries / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D015994:Incidence; D007557:Israel; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012042:Registries / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012253:Rib Fractures / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D012307:Risk Factors; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000175:diagnosis
keywords: abdominal injury; rib fracture