Diagnosis of Rib Fracture and Related Complications in Patients with Blunt Chest Wall Trauma Using Point-of-Care Ultrasound vs. Computed Tomography Scan

Abstract

Background: One of the most common reasons for the referrals of patients to the trauma center is blunt chest injury. Objectives: To determine and compare the diagnostic value of point-of-care ultrasound (POCUS) and computed tomography (CT) scans in detecting rib fractures and their complications in patients with blunt chest wall trauma. Methods: The current cross-sectional study (October 2017-March 2018) was conducted in Shahid Rajaei Hospital, Shiraz, southern Iran. Convenient non-random sampling was employed. Patients with stable vital signs underwent ultra-sonography and later were evaluated by CT scan for fractures and related complications. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPP), positive likelihood ratio (PLR), negative likelihood ratio (NLR), and accuracy were calculated and compared between the two procedures. Results: A total of 113 patients with a mean ± standard deviation (SD) age of 44.07 ± 20.07 years were enrolled, of whom 75 (66.3%) and 62 (54.9%) patients had at least one broken rib based on CT scan and sonography, respectively. The frequency of double fractures was higher than other conditions in both CT scans and ultrasound (35.53% and 37.10%). The overall sensitivity of ultrasound was calculated to be 81.58%, and with an increasing number of broken ribs, the sensitivity of ultrasound also increased (73.08% for identifying patients with one damaged rib versus 100% for detecting patients with five or more broken ribs). None of the 13 definite cases of pneumothorax were detected on ultrasound, while the sensitivity of ultrasound was appropriate for hemothorax and subperiosteal hematoma (85.71% and 80.23%, respectively). Conclusions: Ultrasound offers high sensitivity, specificity, and diagnostic power in diagnosing fractures and their complications, but considering the setting of our study, care should be taken when generalizing the findings of this study.