Not All Black and White: Is Routine Chest Radiography Following Rib Fractures Beneficial?

Our institution recommends patients suffering ≥3 traumatic rib fractures, or any number of fractures with hemothorax (HTX), pneumothorax (PTX), or tube thoracostomy placement during admission follow-up for outpatient chest radiography (oCXR). We assessed the utility of oCXR by identifying risk factors for abnormal radiographic findings and need for postdischarge interventions.

This was a retrospective study of 182 adult patients presenting to a single level 1 trauma center with isolated chest wall injuries and had oCXR within 30 d postdischarge. The primary outcomes were abnormal oCXR pathology (PTX, pleural effusion, lobar consolidation) and postdischarge interventions (repeat evaluation by medical provider, repeat imaging, procedures, and mortality).

A total of 64 patients had abnormal oCXR findings. Sixty-two patients required ≥1 postdischarge interventions. Risk factors for oCXR pathology and postdischarge events were anticoagulation use (P = 0.03; P = 0.04), flail segments (P = 0.04; P = 0.03), and HTX on presentation (P < 0.01; P < 0.01), respectively. oCXR pathology was associated with increased age (P < 0.01), factor Xa inhibitor use (0.03), dementia (P = 0.03), and chest tube placement (P < 0.01). Chronic obstructive pulmonary disease (P = 0.04) and pleural effusion (P = 0.01) were associated with requiring ≥1 postdischarge intervention. PTX and ≥3 fractures were not significant risk factors for either primary outcome.

Anticoagulation use, flail chest, HTX, tube thoracostomy, age, dementia, and chronic obstructive pulmonary disease were associated with oCXR pathology and postdischarge interventions. Three or more rib fractures and PTX were not associated with either primary outcome. Our findings suggest that our institution may benefit from more nuanced screening guidelines to better identify high-risk patients and limit unnecessary imaging.