Research Article
Minör göğüs travmasında radyografinin kaburga kırıklarını tanımada yeterliliği: Sonografi ve radyografinin etkinlik kıyaslaması
Abstract
Giriş: Minör enerjili künt göğüs travması sonrası meydana gelen en yaygın yaralanma, genellikle kaburga kırığıdır (%25) ve genellikle teşhis için radyografik görüntüleme kullanılır. Bununla birlikte, radyografiler bazen, özellikle kıkırdaktaki kırıkları olmak üzere veya yoğun bir şekilde kalsifiye olmadıkça kırıkları gösteremezler. Bu çalışmadaki amaç minör künt göğüs travmalı hastalarda kaburga kırıklarını saptamada ultrasonografinin (US) rolünü araştırıp değerlendirmek ve başarısını posteroanterior (PA) akciğer grafisi ile karşılaştırmaktı.
Yöntem: Çalışmamızda, Haziran 2017 ve Mart 2019 tarihleri arasında travma sonrası şüpheli kaburga kırıklarını değerlendirmek adına daha önce hem US hem de radyografi uygulanmış minör künt göğüs travması olan hastalar dahil edilmiştir. Hastaların tamamına PA projeksiyonunda radyografi çekildi. US çekimi, kaburga kırıklarını ve bütünlüğünü değerlendirme ve tanımlamada uzman bir radyolog tarafından yapıldı. Daha sonra US çekimi ile saptanan ve radyografi ile saptanan kırıkların insidansı, özellikleri ve lokalizasyon bilgileri karşılaştırıldı.
Bulgular: Mevcut çalışmaya toplam 126 hasta dahil edildi. Hastalar arasında 98 hasta (%78) ilk kez, 28 hasta (%22) ise ikinci kez hastaneye başvurmuş olduğu bilgisi tespit edildi (bu hastaların daha önce başka hastanelere başvurmuş olduğu ve radyografik değerlendirme ile 'normal, sağlıklı' olarak değerlendirilmiş ve taburcu edilmiş olduğu tespit edilmiştir). Radyografi ve US incelemeye göre toplam 108 kırık tespit edilmiştir (tamamı 79 hastada (%63)), 47 hastada ise (%37) tanı konulan kırık bulgusu yoktu. Ultrasonografi ile tüm kırıklar (%100) doğru tespit edilirken, radyografide 16 kırık (%14,81) tespit edildi. Radyografi ve US ile tanı konulan hastalar arasında tanısal yetenek açısından istatistiksel olarak anlamlı fark bulundu (p=0,011).
Sonuç: Kaburga kırıkları teşhisinde, ultrasonografik çekim, doğruluk açısından radyografiden önemli ölçüde üstündür. Ultrasonografi travma bölgesinden, lokalizasyon ve yerleşiminden bağımsız olarak radyografiye göre anlamlı üstün bulunmuştur. Ultrasonografik değerlendirmede bazı kaburga alanlarının erişilemeyeceği gerçeğine rağmen, söz konusu minör enerjili göğüs travması olduğunda, en çok etkilenen bölgelerin hızlı bir şekilde değerlendirilmesi en etkili olarak ultrasonografi ile olmaktadır. Bu nedenle US, minör göğüs travmalarında kot kırıklarında tanı doğruluğunu arttırır ve tanı atlanmasını azaltarak da hastaların sağlık kuruluşlarına tekrar tekrar başvurularını azaltmış olur.
Anahtar kelimeler: Kaburga kırıkları, toraks travmaları, travma, ultrasonografi, radyografi
References
- 1. Battle C, Hayward S, Eggert S, Evans PA. Comparison of the use of lung ultrasound and chest radiography in the diagnosis of rib fractures: a systematic review. Emerg Med J 2019;36(3):185-90. http://dx.doi.org/10.1136/emermed-2017-207416
- 2. Henry TS, Donelly EF, Boiselle PM, Crabtree TD, Ianettoni MD, Johnson GB, et al. ACR Appropriateness Criteria® Rib Fractures. J Am Coll Radiol 2019;16(5):227-34. https://doi.org/10.1016/j.jacr.2019.02.019
- 3. Livingston DH, Shogan BS, John P, Lavery, Robert FM. CT diagnosis of rib fractures and the prediction of acute respiratory failure. J Trauma Acute Care Surg 2008;64(4):905-11. https://doi.org/10.1097/ta.0b013e3181668ad7
- 4. Sears MW, Luchette FA, Esposito TJ, Dickson EL, Grant M. Old fashion clinical judgment in the era of protocols: is mandatory chest X-ray necessary in injured patients? J Trauma Acute Care Surg 2005;59(2):324-32. https://doi.org/10.1097/01.ta.0000179450.01434.90
- 5. Tandogan M, Katirci Y, Turan Sonmez F, Duymaz H, Altun S, Gunaydin YK, et al. X-ray and ultrasonography in forearm trauma. Hong Kong J Emergency Med 2015;22(6):352-8. https://doi.org/10.1177/102490791502200603
- 6. He Z, Ahang D, Xiao H, Zhu Q, Xuan Y, Su K. et al. The ideal methods for the management of rib fractures J Thorac Dis 2019;11(Suppl 8): 1078–89. https://doi.org/10.21037/jtd.2019.04.109
- 7. Al-Baghdadi, R, Yu, TJ, Ferro, A, Roberts, J. Radiography versus sonography in the detection of acute fractures: a case series. J Diagnostic Med Sonography 2021;37(4):400-6. https://doi.org/10.1177/8756479321996314
- 8. Çelik A, Akoglu H, Omercikoglu S, Bugdayci O, Karacabey S, Kabaroglu KA, et al. The diagnostic accuracy of ultrasonography for the diagnosis of rib fractures in patients presenting to emergency department with blunt chest trauma. J Emerg Med 2021;60(1):90-7. https://doi.org/10.1016/j.jemermed.2020.06.063
- 9. Gilbertson J, Pageau P, Ritcey B, Cheng W, Burwash-Brennan T, Perry JJ. Test characteristics of chest ultrasonography for rib fractures following blunt chest trauma: a systematic review and meta-analysis. Annals Emerg Med 2022;79(6):529-39. https://doi.org/10.1016/j.annemergmed.2022.02.006
- 10. Lee W, Kim YH, Chee HK, Lee SA. Ultrasonographic evaluation of costal cartilage fractures unnoticed by the conventional radiographic study and multidetector computed tomography. Eur J Trauma Emerg Surg 2012;(38):37-42. https://doi.org/10.1007/s00068-011-0117-2
- 11. Pishbin E, Ahmadi K, Foogardi M, Salehi M, Toosi FS. Movagar VR. Comparison of ultrasonography and radiography in diagnosis of rib fractures. Chin J Traumatol 2017;20(4):226-8. https://doi.org/10.1016/j.cjtee.2016.04.010
- 12. Mattox R, Reckelhoff KE, Welk AB, Kettner NWi. Sonography of occult rib and costal cartilage fractures: a case series. J Chiropractic Med 2014;13(2):139-43. https://doi.org/10.1016/j.jcm.2014.06.008
- 13. Davis S, Affatato A. Blunt chest trauma: utility of radiological evaluation and effect on treatment patterns. Am J Emerg Med 2006;24(4):482-6. https://doi.org/10.1016/j.ajem.2006.03.022
- 14. Bhavnagri SJ, Mohammed TL. When and how to image a suspected broken rib. Cleve Clin J Med 2009;76(5):309-14. https://doi.org/10.3949/ccjm.76a.08026
- 15. Rodriguez RM, Hendey GW, MowerWR. Selective chest imaging for blunt trauma patients: The national emergency X-ray utilization studies (NEXUS-chest algorithm). Am J Emerg Med 2017;35(1):164-70. https://doi.org/10.1016/j.ajem.2016.10.066
- 16. Battle C, Hayward S, Eggert S, Evans PA. Comparison of the use of lung ultrasound and chest radiography in the diagnosis of rib fractures: a systematic review. Emerg Med J 2019;36(3):185-90. http://dx.doi.org/10.1136/emermed-2017-207416
Adequateness of radiography in recognizing rib fractures in minor chest trauma: A comparison of the efficacy of sonography and radiography
Abstract
Introduction: The most common injury resulting from blunt chest trauma is a rib fracture (25%) which is usually visible on radiographs. However, radiographs sometimes cannot show fractures, especially those in cartilage, unless they're densely calcified. The present study aimed to investigate the role of ultrasonography (US) in detecting rib fractures with minor blunt chest trauma and comparing its success with posteroanterior (PA) chest radiography.
Methods: Patients with minor blunt chest trauma who had previously undergone US and radiography to assess suspected rib fractures, between June 2017– March 2019, were included. Radiography was obtained in the PA projection. US was performed by a radiologist who identified fractures by the disruption of the anterior margin of the rib on the US. The incidence and location of the fractures detected by US and radiography were then compared.
Results: Totally 126 patients were included in the study. Ninety-eight patients (78%) were admitted to the hospital for the first time, and 28 patients (22%) for the second time (they previously admitted to the other hospitals and were evaluated as ‘normal’ by radiography). A total of 108 fractures ( in 79 patients (63%) ) were detected based on radiography and US examination, while 47 patients (37%) had no diagnostic evidence of fracture. All fractures were correctly detected by ultrasonography (100%), whereas radiography revealed 16 fractures (14.81%). A statistically significant difference in diagnostic capability was found between patients diagnosed by radiography and US (p=0.001).
Conclusion: Ultrasonographic imaging is significantly superior to radiography in terms of accuracy in diagnosing rib fractures. Ultrasound was found to be significantly superior to radiography regardless of trauma site, localization, and location. Even though some rib areas are inaccessible on ultrasonographic evaluation, rapid evaluation of the most affected areas is most effective with ultrasonography when it comes to minor energy chest trauma. For this reason, the US increases the accuracy of diagnosis in minor chest traumas and rib fractures and decreases the repetitive referral of patients to health institutions by reducing the missed diagnosis.
Keywords: Rib fractures, thoracic injuries, trauma, ultrasonography, radiography
References
- 1. Battle C, Hayward S, Eggert S, Evans PA. Comparison of the use of lung ultrasound and chest radiography in the diagnosis of rib fractures: a systematic review. Emerg Med J 2019;36(3):185-90. http://dx.doi.org/10.1136/emermed-2017-207416
- 2. Henry TS, Donelly EF, Boiselle PM, Crabtree TD, Ianettoni MD, Johnson GB, et al. ACR Appropriateness Criteria® Rib Fractures. J Am Coll Radiol 2019;16(5):227-34. https://doi.org/10.1016/j.jacr.2019.02.019
- 3. Livingston DH, Shogan BS, John P, Lavery, Robert FM. CT diagnosis of rib fractures and the prediction of acute respiratory failure. J Trauma Acute Care Surg 2008;64(4):905-11. https://doi.org/10.1097/ta.0b013e3181668ad7
- 4. Sears MW, Luchette FA, Esposito TJ, Dickson EL, Grant M. Old fashion clinical judgment in the era of protocols: is mandatory chest X-ray necessary in injured patients? J Trauma Acute Care Surg 2005;59(2):324-32. https://doi.org/10.1097/01.ta.0000179450.01434.90
- 5. Tandogan M, Katirci Y, Turan Sonmez F, Duymaz H, Altun S, Gunaydin YK, et al. X-ray and ultrasonography in forearm trauma. Hong Kong J Emergency Med 2015;22(6):352-8. https://doi.org/10.1177/102490791502200603
- 6. He Z, Ahang D, Xiao H, Zhu Q, Xuan Y, Su K. et al. The ideal methods for the management of rib fractures J Thorac Dis 2019;11(Suppl 8): 1078–89. https://doi.org/10.21037/jtd.2019.04.109
- 7. Al-Baghdadi, R, Yu, TJ, Ferro, A, Roberts, J. Radiography versus sonography in the detection of acute fractures: a case series. J Diagnostic Med Sonography 2021;37(4):400-6. https://doi.org/10.1177/8756479321996314
- 8. Çelik A, Akoglu H, Omercikoglu S, Bugdayci O, Karacabey S, Kabaroglu KA, et al. The diagnostic accuracy of ultrasonography for the diagnosis of rib fractures in patients presenting to emergency department with blunt chest trauma. J Emerg Med 2021;60(1):90-7. https://doi.org/10.1016/j.jemermed.2020.06.063
- 9. Gilbertson J, Pageau P, Ritcey B, Cheng W, Burwash-Brennan T, Perry JJ. Test characteristics of chest ultrasonography for rib fractures following blunt chest trauma: a systematic review and meta-analysis. Annals Emerg Med 2022;79(6):529-39. https://doi.org/10.1016/j.annemergmed.2022.02.006
- 10. Lee W, Kim YH, Chee HK, Lee SA. Ultrasonographic evaluation of costal cartilage fractures unnoticed by the conventional radiographic study and multidetector computed tomography. Eur J Trauma Emerg Surg 2012;(38):37-42. https://doi.org/10.1007/s00068-011-0117-2
- 11. Pishbin E, Ahmadi K, Foogardi M, Salehi M, Toosi FS. Movagar VR. Comparison of ultrasonography and radiography in diagnosis of rib fractures. Chin J Traumatol 2017;20(4):226-8. https://doi.org/10.1016/j.cjtee.2016.04.010
- 12. Mattox R, Reckelhoff KE, Welk AB, Kettner NWi. Sonography of occult rib and costal cartilage fractures: a case series. J Chiropractic Med 2014;13(2):139-43. https://doi.org/10.1016/j.jcm.2014.06.008
- 13. Davis S, Affatato A. Blunt chest trauma: utility of radiological evaluation and effect on treatment patterns. Am J Emerg Med 2006;24(4):482-6. https://doi.org/10.1016/j.ajem.2006.03.022
- 14. Bhavnagri SJ, Mohammed TL. When and how to image a suspected broken rib. Cleve Clin J Med 2009;76(5):309-14. https://doi.org/10.3949/ccjm.76a.08026
- 15. Rodriguez RM, Hendey GW, MowerWR. Selective chest imaging for blunt trauma patients: The national emergency X-ray utilization studies (NEXUS-chest algorithm). Am J Emerg Med 2017;35(1):164-70. https://doi.org/10.1016/j.ajem.2016.10.066
- 16. Battle C, Hayward S, Eggert S, Evans PA. Comparison of the use of lung ultrasound and chest radiography in the diagnosis of rib fractures: a systematic review. Emerg Med J 2019;36(3):185-90. http://dx.doi.org/10.1136/emermed-2017-207416
There are 16 citations in total.
Details
| Primary Language | English |
|---|---|
| Subjects | Surgery |
| Journal Section | Original Research |
| Authors | |
| Publication Date | July 31, 2022 |
| Submission Date | December 7, 2021 |
| Acceptance Date | July 25, 2022 |
| Published in Issue | Year 2022Volume: 7 Issue: 3 |
