Blunt chest trauma: utility of radiological evaluation and effect on treatment patterns

Minor chest wall trauma is a common complaint in the emergency department (ED) (Barnea Y, Kashtan H, Skornick Y, Werbin N. Isolated rib fractures in elderly patients: mortality and morbidity. Can J of Surgery 2002;45(1):43-6; Lee RB, Bass SM, Morris JA, Mackenzie EJ. Three or more rib fractures as an indicator for transfer to a level I trauma center. J Trauma 1990;30:689-94; Dubinsky I, Low A. Non-life-threatening blunt chest trauma: Appropriate investigation and treatment. Am J Emerg Med 1997;15(3):240-3). Up to 50% of rib fractures may be missed on standard x-ray (Ziegler DW, Agarwal NN. The morbidity and mortality of rib fractures. J Trauma 1994;37:975-9; Palvanen M, Kannus P, Niemi S, Parkkari J. Hospital-treated minimal-trauma rib fractures in elderly Finns: long-term trends and projections for the future. Osteoperosis International). Little consensus exists among emergency physicians with respect to the workup of minor blunt chest trauma. The purpose of this study was to evaluate the accuracy of emergency physicians in interpreting rib radiographs and to determine if that interpretation resulted in any variance in treatment patterns. Our study is a retrospective study of 271 charts from a community-based teaching hospital from August 2000 to August 2002. Patients were excluded if they suffered major trauma. The treatment rendered was categorized. Categories included over-the-counter medication, nonsteroidal anti-inflammatory drugs, narcotics, and muscle relaxants. The overall chi2 calculation showed no differences between the fractured group and the no fracture group (P=.072). From this, it can be concluded that there were no between-group differences in drugs prescribed based on whether a fracture was diagnosed by the ED physician. Indicating that the interpretation of the rib series does not influence the physicians treatment plan.