Bedside US in the diagnosis of Rib Fractures
Date First Published:
August 28, 2017
Last Updated:
August 28, 2017
Report by:
Kelli Levek , Emergency Medicine Resident Physician (Spectrum Health/Michigan State University Emergency Medicine Residency Program)
Search checked by:
Kelli Levek and Jeff Jones, Spectrum Health/Michigan State University Emergency Medicine Residency Program
Three-Part Question:
In [patients who present to the emergency department with blunt thoracic trauma], how accurate is [bedside ultrasound] compared to [standard chest x-rays] in the [diagnosis of rib fractures]?
Clinical Scenario:
-A 35 y/o male presents to the ER following a low speed MVA. Patient was a restrained driver hit on the front passenger side while turning into a parking lot. He had no LOC and was able to ambulate following the accident. He presents with chest pain on the right and pain with inspiration. Patient is GCS 15 on arrival with HR 88, BP 145/75, RR 18, O2 sat 97% RA, T 37.
Search Strategy:
Medline 1966-05/17 using PubMed, Cochrane Library (2017), and Embase
[(Ultrasonics or ultrasound or ultrasonography) AND (rib fracture or thoracic injury or chest trauma)]. Limit to English language
[(Ultrasonics or ultrasound or ultrasonography) AND (rib fracture or thoracic injury or chest trauma)]. Limit to English language
Outcome:
166 studies were identified; only one trial investigated bedside ultrasound performed by emergency clinicians.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Feasibility of emergency department point-of-care ultrasound for rib fracture diagnosis in minor thoracic injury. Elizabeth Lalande, Chantal Guimont, Marcel Edmond, Marc Charles Parent, Claude Topping, Brice Lion 2016 Canada | Convenience sample of 96 total patients. -Adults, aged 18 and older, presenting to the emergency department after sustaining blunt thoracic ttrauma and with clinical suspicion of rib fractures. t-Exclusions: tt-greater than 96 hours post trauma tt-hemodynamic instability tt-GCS 14 or less tt-with other significant traumatic injury |
Investigational study | 65% of EP concluded that PoCUS was a feasible option for diagnosing rib fractures with a VAS of 63. | PoCUS is a feasible option in the diagnosis of rib fractures in EP patients. | 1. Patients were included based on physician suspicion of rib fractures following blunt thoracic tttrauma. Thus, it seems patients were not randomized. This was a convenience sample. t2. Results were not compared to a gold standard — neither US or Xray are gold standard. CT thorax tis gold standard, but results of US and Xray were not compared to CT results on patients included in tthe study. t3. US is operator dependent and the EPs included had no prior experience with US for diagnosis of trib fractures (they did have at least 9 years of US experience however). |
| 15% of PoCUS were limited by patient discomfort. | Patient discomfort was the largest limiting factor in PoCUS. | ||||
| 29% of patients were diagnosed with rib fractures by PoCUS, not seen on CXR. | PoCUS is able to detect rib fractures not seen by CXR. | ||||
| 11 of 65 patients had rib fractures diagnosed with CXR, not seen on PoCUS. | PoCUS is not 100% reliable in detection of rib fractures. |
Bottom Line:
tIn patients who present to the emergency department with blunt thoracic trauma, PoCUS is a feasible ttechnique for identifying rib fractures when compared to standard chest X-ray.
References:
- Elizabeth Lalande, Chantal Guimont, Marcel Edmond, Marc Charles Parent, Claude Topping, Brice Lion. Feasibility of emergency department point-of-care ultrasound for rib fracture diagnosis in minor thoracic injury.