The significance of first rib fractures in children.

Abstract:

PURPOSE:The purpose of the study was to determine if first rib fractures are associated with an increased incidence of thoracic vascular injury in pediatric patients. METHODS:The medical records of all children diagnosed with a first rib fracture or a central vascular injury after blunt trauma treated at a state-designated level 1 pediatric trauma center from 2000 to 2009 were reviewed. RESULTS:Thirty-three children (0.27% of patients; mean age, 10.9 ± 0.9 years) were identified with either a first rib fracture or thoracic vascular injury owing to blunt trauma. Thirty-two children had a first rib fracture, and only 1 child (3%) had significant thoracic vascular injury. Mediastinal abnormalities (indistinct aortic knob) were identified in 3 children, 2 with first rib fracture on initial chest radiograph. Despite a normal cardiovascular examination result, 25 (74%) children with a normal mediastinum on screening chest radiograph underwent computed tomography. No child with a normal mediastinum on initial chest radiograph was found to have associated intrathoracic injuries requiring further intervention. In children with first rib fractures and a normal mediastinum by screening chest x-ray, the negative predictive value for thoracic vascular injury was 100%. CONCLUSIONS:Children with first rib fractures without mediastinal abnormality on chest radiograph require no further workup for thoracic vascular injury.

journal_name

J Pediatr Surg

authors

Hamilton NA,Bucher BT,Keller MS

doi

10.1016/j.jpedsurg.2010.09.080

subject

Has Abstract

pub_date

2011-01-01 00:00:00

pages

169-72

issue

1

eissn

0022-3468

issn

1531-5037

pii

S0022-3468(10)00901-2

journal_volume

46

pub_type

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