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Rib radiographs for trauma: useful or wasteful?

Authors
  • Thompson, B M
  • Finger, W
  • Tonsfeldt, D
  • Aprahamian, C
  • Troiano, P
  • Hendley, G
  • Mateer, J
  • Stueven, H
Type
Published Article
Journal
Annals of Emergency Medicine
Publisher
Elsevier
Publication Date
Mar 01, 1986
Volume
15
Issue
3
Pages
261–265
Identifiers
PMID: 3946876
Source
Medline
License
Unknown

Abstract

In trauma to the chest, the clinical impression and the physical findings of rib fractures are nonspecific. Fractures often are not seen on initial films. The principal diagnostic goal should be the detection of significant complications (pneumothorax, hemothorax, major vascular injury, or pulmonary contusion) requiring admission. The therapeutic effort should be to provide pain relief and prevent the delayed development of atelectasis or pneumonia in patients with painful chest wall injuries, whether or not a fracture is detected initially. An upright posteroanterior chest radiograph has the greatest yield in detecting fractures and complications resulting from them. Tomograms and expiratory, oblique, and "coned-down" views should not be done routinely. The use of these more specific examinations may be indicated, however, in such cases as trauma to ribs 1 to 3 or 9 to 12. Their selective use in isolated cases (trauma to ribs 1 to 3 or 9 to 12) and suspected child abuse may indicate the need for these more specific examinations. Because detection of pulmonary complications of chest trauma is most important, a delayed or repeat upright posteroanterior chest radiograph may be the most cost-effective second radiograph. Significant medical care cost savings may be appreciated by limiting the use of specific rib views to instances in which it might influence the patient's therapy.

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