Point-of-care ultrasound (POCUS) diagnosis of rib fractures

To review the literature on the role of Point-of-care ultrasound (POCUS) in diagnosing rib fractures compared with other diagnostic modalities and to give recommendations on its role.

Broad text PubMed database search was performed using general terms (rib, fracture, ultrasound, diagnosis) in English language without time restriction. Selected articles were critically read by three acute care physicians who have more than 20 years' experience in POCUS.

Ultrasound, as shown by a recent meta-analysis, had a pooled sensitivity of 89.3%, a pooled specificity of 98.4%, and a pooled positive likelihood ratio of 55.7 without difference between emergency and radiology departments. The uncertainty of evidence was high due to (1) selection bias, (2) geographical bias, and (3) heterogeneity of the operator's experience. POCUS has certain advantages including: (1) it is dynamic so it can evaluate the rib displacement during respiration, (2) It is portable so that it can be used in prehospital setting and disaster situations, (3) it has no risk of radiation so that it can be used in pregnant women, children, and in repeated follow-up, and (4) it has good resolution to evaluate the soft tissues around fractures. In contrast, its limitations include: (1) it is operator dependant, (2) it takes a longer time, (3) it cannot diagnose ribs covered by bones like those under the scapula, and (4) it needs a conscious patient to guide the examination. Ultrasound-guided blocks, including intercostal nerve block, serratus anterior plane block, and erector spinae plane block were successful in controlling the pain of multiple rib fractures.

This review supports the use of POCUS in diagnosing rib fractures, which can be extended into ultrasound-guided blocks for pain control. Nevertheless, it highlights the need for research with higher quality in this area. Ultrasound and CT scan should be complementary and not competitive.