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Background: There is currently no scoring system for rib fractures that relates detailed anatomic variables to patient outcomes. Our objective was to develop and validate a radiographic rib fracture scoring system based on computed tomographic chest findings., Methods: We reviewed our trauma registry from September 2012 to April 2014 for all blunt trauma patients with one or more rib fractures visualized on chest computed tomography. We identified the following six candidate radiographic variables and tested their individual associations with pneumonia, respiratory failure, and tracheostomy: (1) six or more rib fractures, (2) bilateral fractures, (3) flail chest, (4) three or more severely (bicortical) displaced fractures, (5) first rib fracture, and (6) at least one fracture in all three anatomic areas (anterior, lateral, and posterior). We developed the "RibScore" by assigning 1 point for each variable, which was validated among the sample using univariate analyses, test performance characteristics, and the receiver operating characteristic area under the curve c statistic., Results: A total of 385 patients with one or more rib fractures were identified; 274 (71.2%) were males, median age was 48 years, and median Injury Severity Score (ISS) was 17. Of these patients, 156 had six or more rib fractures, 120 had bilateral fractures, 46 had flail chest, 32 had three or more severely displaced fractures, 91 had a first rib fracture, and 58 had fractures in all three anatomic areas. Each RibScore component variable was associated with the three pulmonary outcomes by univariate analysis (p < 0.05). The median RibScore was 1 (range, 0-6). The distribution of the RibScore was as follows: score of 0, 41.9%); score of 1, 23.9%; score of 2, 15.4%; score of 3, 9.9%; score of 4, 7.6%; and score of five, 1.3%. RibScore was linearly associated with pneumonia (p < 0.01), acute respiratory failure (p < 0.01), and tracheostomy (p < 0.01). The receiver operating characteristic areas under the curve for the outcomes were 0.71, 0.71, and 0.75, respectively., Conclusion: The RibScore predicts adverse pulmonary outcomes and represents a standardized assessment of fracture severity that may be used for communication and prognostication of the severely injured trauma patient., Level of Evidence: Prognostic study, level III.

Background: The current management for blunt cerebrovascular injuries (BCVIs) includes repeat imaging 7 days to 10 days after initial diagnosis. This recommendation, however, has not been systematically evaluated. The purpose of this study was to evaluate the impact of early repeat imaging on treatment course. We hypothesized that a minority of patients with high-grade injuries (Grades III and IV) have complete resolution of their injuries early in their treatment course and hence repeat imaging does not alter their therapy., Methods: Our prospective BCVI database was queried from January 1, 1997, to January 1, 2013. Injuries were graded according to the Denver scale. Injuries, treatment, and imaging results were analyzed. BCVI healing was defined as a complete resolution of the injury., Results: During the 16-year study, 582 patients sustained 829 BCVIs; there were 420 carotid artery injuries and 409 vertebral artery injuries. The majority (78%) received antithrombotic therapy. For the 296 carotid artery injuries (70%) with repeat imaging, there was complete healing of the injury in 56% of Grade I, 20% of Grade II, 5% of Grade III, and 0% of Grade IV injuries. For the 255 vertebral artery injuries (62%) with repeat imaging, there was a resolution of the injury in 56% of Grade I, 17% of Grade II, 14% of Grade III, and 3% of Grade IV injuries. For BCVIs overall, there was healing documented in 56% of Grade I, 18% of Grade II, 8% of Grade III, and 2% of Grade IV injuries., Conclusion: Injury grade of BCVIs is associated with the healing rate of the injury. While approximately half of Grade I BCVIs resolved, only 7% of all high-grade injuries healed. Early repeat imaging may not be warranted in high-grade BCVI; the vast majority of injuries do not resolve. The cost, radiation, and transport risk of early repeat imaging should be weighed against the potential treatment impact for individual patients., Level of Evidence: Therapeutic/care management study, level IV.