P073: Feasibility of emergency department targeted ultrasound for rib fracture diagnosis in minor thoracic injury

Introduction: Rib fractures represent a frequent condition associated with Minor Thoracic Injury (MTI). Since the last decade, ultrasound have become an important part of emergency physician’s (EP) daily practice, and its applications have become numerous. The main objective of this study was to evaluate the feasibility of Emergency Department Targeted Ultrasound (EDTU) for rib fracture diagnosis in patients with MTI. Secondary objectives were to 1) evaluate patients’ pain during the EDTU procedure, 2) assess clinicians’ degree of certitude over rib fracture diagnosis made by EDTU, 3) identify the limitations of the use of EDTU technique, and 4) compare the diagnosis obtained with EDTU to radiography results. Methods: Adult patients who presented with clinical suspicion of rib fractures after MTI were included. All patients underwent EDTU performed by emergency physicians (EP) prior to a rib view X-ray. Visual Analogue Scale (VAS) ranging from 0 to 100 was used to ascertain feasibility, patients’ pain and clinicians’ degree of certitude. Feasibility was defined as a score of more than 50 on the VAS. We also documented the radiologists’ interpretation of rib view X-ray. Radiologists were blinded to the EDTU results. Results: Ninety-six patients were included. A majority (65%) of EP concluded that the EDTU technique to diagnose rib fracture was feasible (VAS score > 50). Median score for feasibility was 63. Median score was 31 (Interquartile range (IQR) 5-57) for patients’ pain related to the EDTU examination and 72 (IQR 32-92) for the degree of certitude over the diagnosis made by EDTU. The main limiting factor of the EDTU technique was pain during patient examination (15%). Conclusion: EDTU examination appears to be a feasible technique for rib fractures diagnosis in the ED.

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Feasibility of emergency department point-of-care ultrasound for rib fracture diagnosis in minor thoracic injury

CJEM ◽

10.1017/cem.2016.383 ◽

2016 ◽

Vol 19 (3) ◽

pp. 213-219 ◽

Cited By ~ 2

Author(s):

Élizabeth Lalande ◽

Chantal Guimont ◽

Marcel Émond ◽

Marc Charles Parent ◽

Claude Topping ◽

...

Keyword(s):

Emergency Department ◽

Point Of Care ◽

Rib Fracture ◽

Thoracic Injury ◽

Limiting Factor ◽

Point Of Care Ultrasound ◽

Median Score ◽

Emergency Physicians ◽

X Ray ◽

Fracture Diagnosis

ABSTRACTObjectivesThe main objective of this study was to evaluate the feasibility of emergency department (ED) point-of-care ultrasound (PoCUS) for rib fracture diagnosis in patients with minor thoracic injury (mTI). Secondary objectives were to 1) evaluate patients’ pain during the PoCUS procedure, 2) identify the limitations of the use of PoCUS technique, and 3) compare the diagnosis obtained with PoCUS to radiography results.MethodsAdult patients who presented with clinical suspicion of rib fractures after mTI were included. All patients underwent PoCUS performed by emergency physicians (EPs) prior to a rib view X-ray. A visual analogue scale (VAS) ranging from 0 to 100 was used to ascertain feasibility, patients’ pain and clinicians’ degree of certitude. Feasibility was defined as a score of more than 50 on the VAS. We documented the radiologists’ interpretation of rib view X-ray. Radiologists were blinded to the PoCUS results.ResultsNinety-six patients were included. A majority (65%) of EPs concluded that the PoCUS technique to diagnose rib fracture was feasible (VAS score > 50). Median score for feasibility was 63. Median score was 31 (Interquartile range [IQR] 5–57) for patients’ pain related to the PoCUS. The main limiting factor of the PoCUS technique was pain during patient examination (15%).ConclusionPoCUS examination appears to be a feasible technique for a rib fracture diagnosis in the ED.

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Injuries to the Chest Part 1

10.2310/vasc.2133 ◽

2019 ◽

Author(s):

Erika B. Call ◽

Amy N. Hildreth ◽

J. Jason Hoth

Keyword(s):

Emergency Department ◽

Injury Severity ◽

Flail Chest ◽

Rib Fractures ◽

Pulmonary Contusion ◽

Thoracic Injury ◽

Resuscitative Thoracotomy ◽

Pulmonary Laceration ◽

Tracheobronchial Injury ◽

Early Trauma

Thoracic injury is common and is associated with significant morbidity and mortality. Injuries to the chest are responsible for 25% of blunt trauma fatalities and contribute to an additional 50% of deaths in this population.1 Fortunately, the majority of thoracic injuries can be treated effectively, and often definitively, by relatively simple maneuvers that can be learned and performed by most physicians involved in early trauma care. Only 5 to 10% will require operative intervention.2 These extremes in injury severity are unique to the chest and require treatment by a surgeon with a correspondingly broad range of knowledge and skills. This article will address the following procedures and injuries: tube thoracostomy, thoracotomy, emergency department resuscitative thoracotomy, video-assisted thoracoscopy, chest wall injuries including rib fractures and flail chest, pneumothorax, hemothorax, empyema, pulmonary contusion and laceration, and tracheobronchial injury. This review 6 figures, 1 table, and 49 references. Keywords: Tube thoracoscopy, emergency department resuscitative thoracotomy (EDRT), rib fractures, flail chest, pneumothorax, hemothorax, empyema, pulmonary contusion, pulmonary laceration, tracheobronchial injury

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Diagnostic modalities x-ray and CT chest differ in the management of thoracic injury

Journal of College of Medical Sciences-Nepal ◽

10.3126/jcmsn.v10i1.12764 ◽

2015 ◽

Vol 10 (1) ◽

pp. 22-31

Author(s):

D Chapagain ◽

DJ Reddy ◽

S Shah ◽

KG Shrestha

Keyword(s):

Ct Scan ◽

Motor Vehicle ◽

Rib Fracture ◽

Lung Contusion ◽

Thoracic Injury ◽

Common Mechanism ◽

Early Management ◽

X Ray ◽

Icu Stay ◽

Chest X Ray

Objective: To observe difference in the management of blunt trauma to the chest on the basis of conventional xray and computerised tomography of the chest. Methods: This prospective study was conducted between December 2011 to October 2012 in COMS in Bharatpur,a tertiary referral centre in central Nepal . Clinically stable thoracic injury patients were first evaluated with chest x-ray and the management on this basis was recorded. The findings of the CT chest were assessed and the type of management on the basis of CT was also recorded. Outcome was assessed in terms of mortality, morbidity, hospital and ICU stay with respect to the management on the basis of chest x-ray and CT scan. Results: Of the 129 patients, 74.4% were male and 25.6% were female with the patients ranging in age from 7 to 87 years (mean = 40.41 years). The most common mechanism of trauma to the chest was as a result of a motor vehicle accident (69.8%), followed by fall injury (20.2%). X-ray chest diagnosed rib fracture in 62%, haemothorax in 37%, pneumothorax in 27%, lung contusion in 10% and haemopneumothorax in 21% patients. Similarly CT chest diagnosed rib fracture in 86%, haemothorax in 54%, pneumothorax in 36%, lung contusion in 30% and haemopneumothorax in 30% patients. Mean hospital stay was 9.5 days in the group of patients having management on the basis of x-ray chest relative to mean stay of 10.2 days in the CT- chest group. In the management on the basis of xray group, there was a mean ICU stay of 2.8days compared to mean stays of 3.2 days in CT chest group. Conclusion: Though CT scan of the chest is more informative and differs the management of the blunt chest trauma, one should not forget to advise the cost effective, easily available and initial guiding agent, xray chest for early management of the chest injury patient. DOI: http://dx.doi.org/10.3126/jcmsn.v10i1.12764 Journal of College of Medical Sciences-Nepal, 2014, Vol.10(1); 22-31

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P085: Potential benefits of incentive spirometry following a rib fracture: a propensity-score analysis

CJEM ◽

10.1017/cem.2018.283 ◽

2018 ◽

Vol 20 (S1) ◽

pp. S87-S87

Author(s):

M. Emond ◽

A. Laguë ◽

B. Batomen Kuimi ◽

V. Boucher ◽

C. Guimont ◽

...

Keyword(s):

Propensity Score ◽

Propensity Score Analysis ◽

Pulmonary Complications ◽

Rib Fractures ◽

Rib Fracture ◽

Thoracic Injury ◽

Main Complaint ◽

Score Analysis ◽

Discharged Patients ◽

Incentive Spirometry

Introduction: Incentive spirometry (IS) is commonly used in post-operative patients for respiratory recovery. Literature suggest that it can possibly improve lung function and reduce post-operative pulmonary complication. There is no recommendation about the use of IS in the emergency department (ED). However, rib fractures, a common complaint, increase the risk of pulmonary complications. There is heterogeneous ED practice for the management of rib fractures. The objective of this study is to assess the benefits of IS to reduce potential delayed complications in ED discharged patients with confirmed rib fracture. Methods: This is a prospective observational planned sub-study in 4 canadians ED between November 2006 and May 2012. Non-admitted patients over 16 y.o. with a main complaint of minor thoracic injury and at least one suspected/confirmed rib fracture on radiographs were included. Discharge recommendations of IS use was left to attending physician. IS training was done by ED nurses. Main outcomes were pneumonia, atelectasis and hemothorax within 14 days. Analyses were made with propensity score matching. Results: 450 patients with at least one rib fracture were included. Of these, 182 (40%) received IS with a mean age of 57.0 y.o. Patients with IS seem to have worse condition. 61 (33.5%) had 3 fractures comparatively to 56 (20.9) for patient without IS. Although, the groups were similar for mean age, sex and mechanism of injury. There were in total 76 cases of delayed hemothorax (16.9%), 69 cases of atelectasis (15.3%) and five cases of pneumonia (1.1%). The use of IS was not protector for delayed hemothorax (RR= 0.80, 95% CI [0.45 1.36]) and nor for atelectasis or pneumonia (RR=0.74, 95% CI [0.45 1.36]) Conclusion: Our results suggest that unsupervised and broad incentive spirometry use does not seem to add a protective effect against the development of delayed pulmonary complications after a rib fracture. Further study should be made to assess the usefulness of IS in specific injured population in the ED.

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Injuries to the Chest Part 1

DeckerMed Surgery ◽

10.2310/surg.2133 ◽

2019 ◽

Author(s):

Erika B. Call ◽

Amy N. Hildreth ◽

J. Jason Hoth

Keyword(s):

Emergency Department ◽

Injury Severity ◽

Flail Chest ◽

Rib Fractures ◽

Pulmonary Contusion ◽

Thoracic Injury ◽

Resuscitative Thoracotomy ◽

Pulmonary Laceration ◽

Tracheobronchial Injury ◽

Early Trauma

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Delayed complications and functional outcome of isolated sternal fracture after emergency department discharge: a prospective, multicentre cohort study

CJEM ◽

10.1017/cem.2016.326 ◽

2016 ◽

Vol 18 (5) ◽

pp. 349-357 ◽

Cited By ~ 4

Author(s):

Samuel Racine ◽

Marcel Émond ◽

Jean-Sébastien Audette-Côté ◽

Natalie Le Sage ◽

Chantal Guimont ◽

...

Keyword(s):

Emergency Department ◽

Cohort Study ◽

Functional Outcome ◽

Thoracic Trauma ◽

Severe Disability ◽

Rib Fracture ◽

Thoracic Injury ◽

Sternal Fracture ◽

Delayed Complications

AbstractObjectiveThe aim of this study was to determine the incidence of delayed complications, specifically hemothorax, and functional outcome in patients with isolated sternal fracture discharged from the emergency department (ED) compared to patients with other minor thoracic trauma.MethodsThis prospective cohort study was conducted in four university-affiliated Canadian EDs. Patients ages 16 and older discharged from the ED with an isolated minor thoracic injury were included and categorized as isolated sternal fracture, rib fracture, or no fracture. A standardized clinical and radiological follow-up was performed at 7 and 14 days as well as a phone follow-up at 30 and 90 days post-injury. Functional outcome was determined using the Medical Outcome Short-Form Health Survey (SF-12).ResultsA total of 969 patients were included, of whom 32 (3.3%) had an isolated sternal fracture, 304 (31.3%) had rib fracture, and 633 (65.3%) had no fracture. Within 14 days, 112 patients presented with a delayed hemothorax: 12.5% of sternal fracture patients, 23% of rib fracture(s) patients, and 6% of minor thoracic injury patients without fracture (p<0.05). At 90 days, 57.1% of patients with sternal fracture had moderate to severe disability compared to 25.4% and 21.2% for both of the other groups, respectively (p<0.001).ConclusionIn this prospective study, we found that 12.5% (n=4,p<0.05) of patients with sternal fracture developed a delayed hemothorax, but the clinical significance of this remains questionable. The proportion of patients with sternal fracture who had moderate to severe disability was significantly higher than that of patients with other minor thoracic trauma.

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First rib fractures as indicators of serious intra and extra-thoracic injury in polytrauma and their impact on the morbidity and mortality

International Surgery Journal ◽

10.18203/2349-2902.isj20191251 ◽

2019 ◽

Vol 6 (4) ◽

pp. 1056

Author(s):

Majed Al-Mourgi

Keyword(s):

Cervical Spine ◽

Injury Severity ◽

Motor Vehicle ◽

Rib Fractures ◽

Rib Fracture ◽

Morbidity And Mortality ◽

Pulmonary Contusion ◽

Thoracic Injury ◽

Thoracic Injuries ◽

First Rib

Background: First-rib fractures are relatively rare compared with fractures of other ribs because of the broad structure deeply placed and protected location of the first rib. A high amount of energy is needed to cause a first-rib fracture; violent trauma, such as that involving motor vehicle accident, is a frequent cause of these fractures, as well as other serious intra-thoracic, head, cervical spine, and intra-abdominal injuries. First-rib fractures have traditionally been considered indicators of increased injury severity and mortality in major trauma patients. The aim was to study the significance of first-rib fractures as indicators of serious intra-thoracic and extra-thoracic injury in polytrauma and their impact on the morbidity and mortality in a high-altitude area in Al-Taif, Saudi Arabia.Methods: This is a retrospective study conducted in King Abdul-Aziz Specialist Hospital (KASH), Taif City, KSA. Patients with chest injuries who presented to the emergency department and were admitted to the hospital between November 2013 and March 2016 were included in the study. Data regarding first-rib fracture were collected, and the relationship between first-rib injuries and associated intra-thoracic and extra-thoracic injuries was analyzed.Results: There was a high incidence of first-rib fracture (23.45%), and 35.8% were bilateral. The most common associated chest injury was a pulmonary contusion (58.5%), followed by pneumothorax (32.1%), hemopneumothorax (20.7%), and surgical emphysema (20.7%). The most common associated extra-thoracic injuries in our study were skeletal injuries (47.4%), cervical spine injuries (11.3%), and head trauma (24.5%).Conclusions: Fractures of the first-rib are associated with serious thoracic and extra-thoracic injuries; they are associated only with increased morbidity in patients with polytrauma and have no independent impact on mortality.

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342 Rib Fracture Scoring at The Royal Sussex County Hospital, A Major Trauma Centre

British Journal of Surgery ◽

10.1093/bjs/znab134.408 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

H Harris ◽

Z Mitha ◽

D White ◽

W Davies

Keyword(s):

Scoring System ◽

Multidisciplinary Care ◽

Rib Fractures ◽

Rib Fracture ◽

County Hospital ◽

Sample Population ◽

Post Intervention ◽

Sussex County ◽

Chest Infection ◽

Major Trauma Centre

Abstract Introduction In April 2017, The Royal Sussex County Hospital introduced rib fracture scoring to help guide the management of rib fractures. Rib fracture score = (number of fractures x number of sides) + age score1 In this study, we audit our adherence to the scoring system and compare our management of chest trauma before and after its implementation. Method All admissions with rib fractures between 1/10/2016- 28/02/2017 (N = 35) and 1/10/2019- 31/01/2020 (N = 41) were recorded. Electronic and written notes were used to retrospectively record multidisciplinary care involvement, analgesics, chest infection and death. Results The pre-intervention cohort had an average age of 55.1 years and rib score of 8.8. The post intervention cohort had an average age of 67.2 years and score of 11.3. Following implementation, 45% of patients had a rib score recorded. Post-intervention, anaesthetic involvement increased by 34.5% and 15.4% more patients received a regional block. Inpatient nights fell from 11.2 to 10.1, mortality rate from 7% to 4% but the incidence of chest infection remained similar. Conclusions The implementation of a rib fracture scoring system has led to greater multidisciplinary care and higher levels of pain management. A larger study is required to assess patient outcome given the change in sample population over time.

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