Rib fractures and their association With solid organ injury: higher rib fractures have greater significance for solid organ injury screening

•The right-sided middle segment ribs have highest association with liver injury.•The left-sided middle segment ribs have highest association with spleen injury.•Advanced Trauma Life Support guidelines should consider middle and lower segment rib fractures for solid organ injury.

BackgroundThe purpose of this study was to identify patients with rib injuries who were at risk for solid organ injury.MethodsA retrospective chart review was performed of all blunt trauma patients with rib fractures during the period from July 2007 to July 2012. Data were analyzed for association of rib fractures and solid organ injury.ResultsIn all, 1,103 rib fracture patients were identified; 142 patients had liver injuries with 109 (77%) associated right rib fractures. Right-sided rib fractures with highest sensitivity for liver injury were middle rib segment (5 to 8) and lower segment (9 to 12) with liver injury sensitivities of 68% and 43%, respectively (P < .001); 151 patients had spleen injuries with 119 (79%) associated left rib fractures. Left middle segment rib fractures and lower segment rib fractures had sensitivities of 80% and 63% for splenic injury, respectively (P < .003).ConclusionsRib fractures higher in the thoracic cage have significant association with solid organ injury. Using rib fractures from middle plus lower segments as indication for abdominal screening will significantly improve rib fracture sensitivity for identification of solid organ injury.