First rib fracture: A harbinger of severe trauma?

Robert E Luceri, Nina E Glass, Joanelle A Bailey, Ziad C Sifri, Anastasia Kunac, Stephanie L Bonne, Peter P Yonclas, Anne C Mosenthal, David H Livingston

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Prior to routine CT scanning, first rib fractures (FRFs) were considered a harbinger of great vessel injuries. We hypothesized FRFs identified on screening CXR have significant associated injuries, while those identified on CT alone do not.

METHODS: We reviewed adult blunt thoracic trauma patients 2014-2015 to identify all FRFs and then tabulated demographics, injury characteristics, and outcomes.

RESULTS: Of 429 patients with chest trauma, 56 had a FRF. CXR diagnosed 20% and CT 80%. Those diagnosed on CXR were older (61 vs 48 p = 0.03), had more severe chest trauma (45% vs 13% chest AIS>3, p = 0.029), longer ICU stays (10 vs 4 days, p = 0.046), and risk for intubation (73% vs 27%, p = 0.011). There was only one major vascular injury in each group. Most FRF patients had associated injuries, including 82% with pelvic fractures.

CONCLUSIONS: Widespread use of CT scanning has resulted in a 5-fold increase in FRF diagnoses. While vascular injuries are not common, especially when identified on initial CXR, FRFs correlate with morbidity and associated injuries.

SHORT SUMMARY: This retrospective review of patients with blunt chest trauma identified 56 patients with first rib fractures, 20% of which were seen on plain chest radiograph. When a first rib fracture was seen on initial CXR it was associated with increased severity of injury and worse clinical outcomes including need for intubation and length of ICU stay. Patients with first rib fractures had few major vascular injuries. However, they did have high rates of concomitant injuries including 82% with pelvic fractures.

Original languageEnglish (US)
JournalAmerican Journal of Surgery
DOIs
StateE-pub ahead of print - Jul 24 2018
Externally publishedYes

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Rib Fractures
Wounds and Injuries
Thorax
Vascular System Injuries
Intubation
Length of Stay

Cite this

Luceri, Robert E ; Glass, Nina E ; Bailey, Joanelle A ; Sifri, Ziad C ; Kunac, Anastasia ; Bonne, Stephanie L ; Yonclas, Peter P ; Mosenthal, Anne C ; Livingston, David H. / First rib fracture : A harbinger of severe trauma?. In: American Journal of Surgery. 2018.
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title = "First rib fracture: A harbinger of severe trauma?",
abstract = "BACKGROUND: Prior to routine CT scanning, first rib fractures (FRFs) were considered a harbinger of great vessel injuries. We hypothesized FRFs identified on screening CXR have significant associated injuries, while those identified on CT alone do not.METHODS: We reviewed adult blunt thoracic trauma patients 2014-2015 to identify all FRFs and then tabulated demographics, injury characteristics, and outcomes.RESULTS: Of 429 patients with chest trauma, 56 had a FRF. CXR diagnosed 20{\%} and CT 80{\%}. Those diagnosed on CXR were older (61 vs 48 p = 0.03), had more severe chest trauma (45{\%} vs 13{\%} chest AIS>3, p = 0.029), longer ICU stays (10 vs 4 days, p = 0.046), and risk for intubation (73{\%} vs 27{\%}, p = 0.011). There was only one major vascular injury in each group. Most FRF patients had associated injuries, including 82{\%} with pelvic fractures.CONCLUSIONS: Widespread use of CT scanning has resulted in a 5-fold increase in FRF diagnoses. While vascular injuries are not common, especially when identified on initial CXR, FRFs correlate with morbidity and associated injuries.SHORT SUMMARY: This retrospective review of patients with blunt chest trauma identified 56 patients with first rib fractures, 20{\%} of which were seen on plain chest radiograph. When a first rib fracture was seen on initial CXR it was associated with increased severity of injury and worse clinical outcomes including need for intubation and length of ICU stay. Patients with first rib fractures had few major vascular injuries. However, they did have high rates of concomitant injuries including 82{\%} with pelvic fractures.",
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First rib fracture : A harbinger of severe trauma? / Luceri, Robert E; Glass, Nina E; Bailey, Joanelle A; Sifri, Ziad C; Kunac, Anastasia; Bonne, Stephanie L; Yonclas, Peter P; Mosenthal, Anne C; Livingston, David H.

In: American Journal of Surgery, 24.07.2018.

Research output: Contribution to journalArticle

TY - JOUR

T1 - First rib fracture

T2 - A harbinger of severe trauma?

AU - Luceri, Robert E

AU - Glass, Nina E

AU - Bailey, Joanelle A

AU - Sifri, Ziad C

AU - Kunac, Anastasia

AU - Bonne, Stephanie L

AU - Yonclas, Peter P

AU - Mosenthal, Anne C

AU - Livingston, David H

N1 - Copyright © 2018 Elsevier Inc. All rights reserved.

PY - 2018/7/24

Y1 - 2018/7/24

N2 - BACKGROUND: Prior to routine CT scanning, first rib fractures (FRFs) were considered a harbinger of great vessel injuries. We hypothesized FRFs identified on screening CXR have significant associated injuries, while those identified on CT alone do not.METHODS: We reviewed adult blunt thoracic trauma patients 2014-2015 to identify all FRFs and then tabulated demographics, injury characteristics, and outcomes.RESULTS: Of 429 patients with chest trauma, 56 had a FRF. CXR diagnosed 20% and CT 80%. Those diagnosed on CXR were older (61 vs 48 p = 0.03), had more severe chest trauma (45% vs 13% chest AIS>3, p = 0.029), longer ICU stays (10 vs 4 days, p = 0.046), and risk for intubation (73% vs 27%, p = 0.011). There was only one major vascular injury in each group. Most FRF patients had associated injuries, including 82% with pelvic fractures.CONCLUSIONS: Widespread use of CT scanning has resulted in a 5-fold increase in FRF diagnoses. While vascular injuries are not common, especially when identified on initial CXR, FRFs correlate with morbidity and associated injuries.SHORT SUMMARY: This retrospective review of patients with blunt chest trauma identified 56 patients with first rib fractures, 20% of which were seen on plain chest radiograph. When a first rib fracture was seen on initial CXR it was associated with increased severity of injury and worse clinical outcomes including need for intubation and length of ICU stay. Patients with first rib fractures had few major vascular injuries. However, they did have high rates of concomitant injuries including 82% with pelvic fractures.

AB - BACKGROUND: Prior to routine CT scanning, first rib fractures (FRFs) were considered a harbinger of great vessel injuries. We hypothesized FRFs identified on screening CXR have significant associated injuries, while those identified on CT alone do not.METHODS: We reviewed adult blunt thoracic trauma patients 2014-2015 to identify all FRFs and then tabulated demographics, injury characteristics, and outcomes.RESULTS: Of 429 patients with chest trauma, 56 had a FRF. CXR diagnosed 20% and CT 80%. Those diagnosed on CXR were older (61 vs 48 p = 0.03), had more severe chest trauma (45% vs 13% chest AIS>3, p = 0.029), longer ICU stays (10 vs 4 days, p = 0.046), and risk for intubation (73% vs 27%, p = 0.011). There was only one major vascular injury in each group. Most FRF patients had associated injuries, including 82% with pelvic fractures.CONCLUSIONS: Widespread use of CT scanning has resulted in a 5-fold increase in FRF diagnoses. While vascular injuries are not common, especially when identified on initial CXR, FRFs correlate with morbidity and associated injuries.SHORT SUMMARY: This retrospective review of patients with blunt chest trauma identified 56 patients with first rib fractures, 20% of which were seen on plain chest radiograph. When a first rib fracture was seen on initial CXR it was associated with increased severity of injury and worse clinical outcomes including need for intubation and length of ICU stay. Patients with first rib fractures had few major vascular injuries. However, they did have high rates of concomitant injuries including 82% with pelvic fractures.

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DO - 10.1016/j.amjsurg.2018.07.034

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C2 - 30060914

JO - American Journal of Surgery

JF - American Journal of Surgery

SN - 0002-9610

ER -