Discrepancies in rib fracture severity between radiologist and surgeon: A retrospective review

Abstract

BACKGROUND:Chest computed tomography (CT) scans are important for the management of rib fracture patients, especially when determining indications for surgical stabilization of rib fractures (SSRFs). Chest CTs describe the number, patterns, and severity of rib fracture displacement, driving patient management and SSRF indications. Literature is scarce comparing radiologist versus surgeon rib fracture description. We hypothesize there is significant discrepancy between how radiologists and surgeons describe rib fractures. METHODS:This was an institutional review board-approved, retrospective study conducted at a Level I academic center from December 2016 to December 2017. Adult patients (≥18 years of age) suffering rib fractures with a CT chest where included. Basic demographics were obtained. Outcomes included the difference between radiologist versus surgeon description of rib fractures and differences in the number of fractures identified. Rib fracture description was based on current literature: 1, nondisplaced; 2, minimally displaced (<50% rib width); 3, severely displaced (≥50% rib width); 4, bicortically displaced; 5, other. Descriptive analysis was used for demographics and paired t test for statistical analysis. Significance was set at p = 0.05. RESULTS:Four hundred and ten patients and 2,337 rib fractures were analyzed. Average age was 55.6(±20.6); 70.5% were male; median Injury Severity Score was 16 (interquartile range, 9-22) and chest Abbreviated Injury Scale score was 3 (interquartile range, 3-3). For all descriptive categories, radiologists consistently underappreciated the severity of rib fracture displacement compared with surgeon assessment and severity of displacement was not mentioned for 35% of rib fractures. The mean score provided by the radiologist was 1.58 (±0.63) versus 1.78 (±0.51) by the surgeon (p < 0.001). Radiologists missed 138 (5.9%) rib fractures on initial CT. The sensitivity of the radiologist to identify a severely displaced rib fracture was 54.9% with specificity of 79.9%. CONCLUSION:Discrepancy exists between radiologist and surgeon regarding rib fracture description on chest CT as radiologists routinely underappreciate fracture severity. Surgeons need to evaluate CT scans themselves to appropriately decide management strategies and SSRF indications.

Evaluation of surgical outcomes in elderly patients with rib fractures: A single-centre propensity score matching study

“…Therefore, the surgical treatment of SSRF has pros and cons—it can accelerate patient recovery and improve their quality of life, but it may extend the length of hospital stay and increase the risk of hospitalization during the perioperative period. Doctors should carefully evaluate a patient's condition and surgical indications and the risks and benefits of surgery to choose the optimum treatment ( 38 , 42 , 43 ).…”

Finite element analysis for better evaluation of rib fractures: A pilot study

“…1,[4][5][6] Given the frequency and associated complications of rib fractures, surgical stabilization of rib fractures (SSRF) has become a viable treatment option for these patients to minimize these complications. 1,7 Despite this appreciation for SSRF, there still remains hesitancy for providing this procedure. This is likely due to the controversy surrounding the indications for SSRF.…”

“…Rib fractures are a common injury following blunt chest trauma occurring in approximately 50% of these patients 1–3 . In addition, rib fractures are fraught with complications including pneumonia, pleural effusions, aspiration, severe respiratory compromise, pulmonary emboli, and lobar collapse 1,4–6 .…”

“…R ib fractures are a common injury following blunt chest trauma occurring in approximately 50% of these patients. [1][2][3] In addition, rib fractures are fraught with complications including pneumonia, pleural effusions, aspiration, severe respiratory compromise, pulmonary emboli, and lobar collapse. 1,[4][5][6] Given the frequency and associated complications of rib fractures, surgical stabilization of rib fractures (SSRF) has become a viable treatment option for these patients to minimize these complications.…”

“…[1][2][3] In addition, rib fractures are fraught with complications including pneumonia, pleural effusions, aspiration, severe respiratory compromise, pulmonary emboli, and lobar collapse. 1,[4][5][6] Given the frequency and associated complications of rib fractures, surgical stabilization of rib fractures (SSRF) has become a viable treatment option for these patients to minimize these complications. 1,7 Despite this appreciation for SSRF, there still remains hesitancy for providing this procedure.…”