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Incidence and Imaging Findings of Costal Cartilage Fractures in Patients with Blunt Chest Trauma: A Retrospective Review of 1461 Consecutive Whole-Body CT Examinations for Trauma
- Source :
- Radiology. 286:696-704
- Publication Year :
- 2018
- Publisher :
- Radiological Society of North America (RSNA), 2018.
-
Abstract
- Purpose To assess the incidence of costal cartilage (CC) fractures in whole-body computed tomographic (CT) examinations for blunt trauma and to evaluate distribution of CC fractures, concomitant injuries, mechanism of injury, accuracy of reporting, and the effect on 30-day mortality. Materials and Methods Institutional review board approval was obtained for this retrospective study. All whole-body CT examinations for blunt trauma over 36 months were reviewed retrospectively and chest trauma CT studies were evaluated by a second reader. Of 1461 patients who underwent a whole-body CT examination, 39% (574 of 1461) had signs of thoracic injuries (men, 74.0% [425 of 574]; mean age, 46.6 years; women, 26.0% [149 of 574]; mean age, 48.9 years). χ2 and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Interobserver agreement was calculated by using Cohen kappa values. Results A total of 114 patients (men, 86.8% [99 of 114]; mean age, 48.6 years; women, 13.2% [15 of 114]; mean age, 45.1 years) had 221 CC fractures. The incidence was 7.8% (114 of 1461) in all whole-body CT examinations and 19.9% (114 of 574) in patients with thoracic trauma. Cartilage of rib 7 (21.3%, 47 of 221) was most commonly injured. Bilateral multiple consecutive rib fractures occurred in 36% (41 of 114) versus 14% (64 of 460) in other patients with chest trauma (OR, 3.48; 95% CI: 2.18, 5.53; P < .0001). Hepatic injuries were more common in patients with chest trauma with CC fractures (13%, 15 of 114) versus patients with chest trauma without CC fractures (4%, 18 of 460) (OR, 3.72; 95% CI: 1.81, 7.64; P = .0001), as well as aortic injuries (n = 4 vs n = 0; P = .0015; OR, unavailable). Kappa value for interobserver agreement in detecting CC fractures was 0.65 (substantial agreement). CC fractures were documented in 39.5% (45 of 114) of primary reports. The 30-day mortality of patients with CC fractures was 7.02% (eight of 114) versus 4.78% (22 of 460) of other patients with chest trauma (OR, 1.50; 95% CI: 0.65, 3.47; P = .3371). Conclusion CC fractures are common in high-energy blunt chest trauma and often occur with multiple consecutive rib fractures. Aortic and hepatic injuries were more common in patients with CC fractures than in patients without CC fractures. © RSNA, 2017.
- Subjects :
- Adult
Male
Fractures, Cartilage
medicine.medical_specialty
Adolescent
Rib Fractures
Synchondrosis
Wounds, Nonpenetrating
030218 nuclear medicine & medical imaging
Young Adult
03 medical and health sciences
0302 clinical medicine
Blunt
medicine
Humans
Whole Body Imaging
Radiology, Nuclear Medicine and imaging
Aged
Retrospective Studies
Aged, 80 and over
Rib cage
business.industry
Incidence (epidemiology)
Retrospective cohort study
Middle Aged
Costal cartilage
3. Good health
Surgery
Costal Cartilage
medicine.anatomical_structure
Blunt trauma
Concomitant
Female
Radiology
Tomography, X-Ray Computed
business
030217 neurology & neurosurgery
Subjects
Details
- ISSN :
- 15271315 and 00338419
- Volume :
- 286
- Database :
- OpenAIRE
- Journal :
- Radiology
- Accession number :
- edsair.doi.dedup.....b7d504dc8dcd776a471a949f58e60280