A review of 39 patients with a total of 204 rib fractures showed no statistically significant difference in sensitivity, specificity, or level of confidence between standard images and dual-energy subtraction images [9]. Radiography Rib Views While still performed in many practices, rib detail radiograph series rarely add additional information to the PA film that would change treatment as has been shown in two retrospective studies. In a review of 422 patients presenting to a university-affiliated emergency department for suspected rib fracture, Shuaib et al [10] found that rib series resulted in a change of management in only one patient (0.23%). Moreover, these authors found that, compared to standard PA radiographs, rib series negatively impacted patient care by prolonging report turnaround time [10]. Hoffstetter et al [11] retrospectively reviewed 609 patients that underwent rib series in the emergency department and found that while diagnosing a higher number of rib fractures as compared to PA radiographs alone, there was no statistically significant difference in the number of patients who received medical treatment. If rib series are to be performed, Park et al [12] showed that interpreting images with both conventional grayscale and inverted grayscale views may improve detection of rib fractures, although this study did not assess if the improved detection had an effect on outcomes. CT Chest The increased sensitivity of CT for the detection of rib fractures does not necessarily alter the management or clinical outcomes of patients without associated injuries. Kea et al [13] reported that CT detected rib fractures in 66 of 589 patients (11%) who had initial chest radiographs interpreted as normal at a level I trauma center, but none of the rib fractures were considered of major clinical significance. The presence and number of rib fractures, and the degree of displacement of the fractures, may carry prognostic significance.
Rib Fractures. A review of 39 patients with a total of 204 rib fractures showed no statistically significant difference in sensitivity, specificity, or level of confidence between standard images and dual-energy subtraction images [9]. Radiography Rib Views While still performed in many practices, rib detail radiograph series rarely add additional information to the PA film that would change treatment as has been shown in two retrospective studies. In a review of 422 patients presenting to a university-affiliated emergency department for suspected rib fracture, Shuaib et al [10] found that rib series resulted in a change of management in only one patient (0.23%). Moreover, these authors found that, compared to standard PA radiographs, rib series negatively impacted patient care by prolonging report turnaround time [10]. Hoffstetter et al [11] retrospectively reviewed 609 patients that underwent rib series in the emergency department and found that while diagnosing a higher number of rib fractures as compared to PA radiographs alone, there was no statistically significant difference in the number of patients who received medical treatment. If rib series are to be performed, Park et al [12] showed that interpreting images with both conventional grayscale and inverted grayscale views may improve detection of rib fractures, although this study did not assess if the improved detection had an effect on outcomes. CT Chest The increased sensitivity of CT for the detection of rib fractures does not necessarily alter the management or clinical outcomes of patients without associated injuries. Kea et al [13] reported that CT detected rib fractures in 66 of 589 patients (11%) who had initial chest radiographs interpreted as normal at a level I trauma center, but none of the rib fractures were considered of major clinical significance. The presence and number of rib fractures, and the degree of displacement of the fractures, may carry prognostic significance.