ARTIK ELİMİZDE DAHA FAZLA KANIT VAR; ULTRASONOGRAFİ KABURGA KIRIKLARININ GÖSTERİLMESİNDE GÜVENİLİR BİR ARAÇTIR

Yıl 2024, , 438 - 442, 21.10.2024

Elif Dilara Topcuoğlu , Sinan Cem Uzunget , Tevfik Kaplan , Zamir Kemal Ertürk , Gökçe Kaan Ataç

https://doi.org/10.18229/kocatepetip.1394202

Öz

AMAÇ: Bu çalışmanın amacı künt göğüs travmasında şüpheli kosta kırıklarının ultrasonografi (US) değerlendirmesinde gözlemciler arası güvenilirliği ölçerek US’un tanısal değerini belirlemektir.
GEREÇ VE YÖNTEM: Künt göğüs travması nedeniyle acil servise başvuran ve kosta kırığı şüphesi olan, yaş ortalaması 48 olan (18 ila 95 yaş) toplam 52 hasta (32 erkek, 20 kadın) çalışmaya dahil edildi. Tüm hastaların direk akciğer grafileri ve US incelemeleri iki radyolog (20 yıllık US deneyimi olan bir kıdemli radyolog hekim ve bir yıllık US deneyimi olan bir asistan hekim) tarafından bağımsız şekilde değerlendirildi.
BULGULAR: Akciğer grafisinde sadece iki kosta kırığı tespit edildi. Her iki radyolog tarafından yapılan US incelemede 19 hastada 22 kırık tespit edildi. Sadece bir kosta kırığı kıdemli radyolog hekim tarafından fark edildi, asistan hekim tarafından fark edilmedi. US ile kosta kırığı tespitinde gözlemciler arası uyum çok iyiydi (Kappa: 0.917) ve bu uyum istatistiksel olarak anlamlıydı (p=0.002). Tüm kırıklar kostanın kemik kısmında yer almaktaydı ve kostal kıkırdak veya kostokondral bileşkede kırık saptanmadı.
SONUÇ: Bu çalışma ile kosta kırığı tanısında US incelemenin, gözlemciler arası değişkenliğinin çok düşük olduğunu ve yüksek oranda tekrarlanabilir bir tanı aracı olduğunu gösterdik.

Anahtar Kelimeler

Gözlemciler arası değişkenlik, Kosta kırığı, Radyografi, Ultrasonografi.

WE HAVE MORE EVIDENCE THAN BEFORE; ULTRASONOGRAPHY IS A RELIABLE TOOL TO SHOW RIB FRACTURES

Öz

OBJECTIVE: The aim of this study is to assess the value of ultrasonography (US) by determining the inter-observer reliability on US evaluation of suspected rib fractures in blunt chest trauma.
MATERIAL AND METHODS: A total of 52 patients (32 males, 20 females) with a mean age of 48 years (18-95 years) who presented to the emergency department with blunt chest trauma and suspected rib fracture were included in the study. All patients were assessed with US by two radiologists (a senior radiologist with 20 years of US experience and a resident with one year of US experience) independently and chest x-rays were also evaluated.
RESULTS: Only two rib fractures were detected on chest x-rays. 22 fractures were detected from 19 patients with US by both radiologists. One rib fracture was noted only by the senior radiologist and not by the resident. Interobserver agreement was very good (kappa: 0.917) and statistically significant (p=0.002). All fractures were located at the bony portion of the rib and no fracture was found at the costal cartilage or costochondral junction.
CONCLUSIONS: We demonstrated that US is a highly reproducible diagnostic tool for rib fractures with very low inter-observer variability.

Anahtar Kelimeler

Interobserver variability, Rib fractures, Radiography, Ultrasonography.

Kaynakça

• 1. Griffith JF, Rainer TH, Ching AS, et al. Sonography compared with radiography in revealing acute rib fracture. AJR. 1999;173(6):1603-09.
• 2. Hurley ME, Keye GD, Hamilton S. Is ultrasound really helpful in the detection of rib fractures? Injury. 2004;35(6):562-6.
• 3. De Maeseneer M, De Mey J, Lenchik L, et al. Helical CT of Rib Lesions: A Pattern-Based Approach. AJR. 2004;182(1):173-9.
• 4. Kara M, Dikmen E, Erdal HH, Simsir I, Altan Kara S. Disclosure of unnoticed rib fractures with the use of ultrasonography in minor blunt chest trauma. Eur J Cardiothoracic Surg. 2003;24(4):608-13.
• 5. Pishbin E, Ahmadi K, Foogardi M, et al. Comparison of ultrasonography and radiography in diagnosis of rib fractures. Chin J Traumatol. 2017;20:226–8.
• 6. Gilbertson J, Pageau P, Ritcey B, et al. Test Characteristics of Chest Ultrasonography for Rib Fractures Following Blunt Chest Trauma: A Systematic Review and Meta-analysis. Ann Emerg Med. 2022, 79.6:529-539.
• 7. Awais M, Salam B, Nadeem N, Rehman A, Baloch NU. Diagnostic Accuracy of Computed Tomography Scout Film and Chest X-ray for Detection of Rib Fractures in Patients with Chest Trauma: A Cross-sectional Study. Cureus. 2019;(13);11:3875.
• 8. Bhavnagri SJ, Mohammed TL. When and how to image a suspected broken rib. Cleve Clin J Med. 2009;76(5):309-14.
• 9. Rainer TH, Griffith JF, Lam E, et al. Comparison of thoracic ultrasound, clinical acumen, and radiography in patients with minor chest injury. J Trauma. 2004;56:1211-3.
• 10. Kelloff J, Hulett R, Spivey M. Acute rib fracture diagnosis in an infant by US: a matter of child protection. Pediatr Radiol. 2009;39(1):70-2.
• 11. Çelik A, Akoglu H, Omercikoglu S, et al. The diagnostic accuracy of ultrasonography for the diagnosis of rib fractures in patients presenting to emergency department with blunt chest trauma. J Emerg Med. 2021;60(1):90-7.
• 12. Talbot BS, Gange Jr CP, Chaturvedi A, et al.Traumatic rib injury: patterns, imaging pitfalls, complications, and treatment. Radiographics. 2017;37(2), 628-51.
• 13. Livingston DH, Shogan B, John P, Lavery RF. CT diagnosis of rib fractures and the prediction of acute respiratory failure. J Trauma. 2008;64(4):905-11.
• 14. Henry TS, Donnelly EF, Boiselle PM, et al. ACR appropriateness Criteria® rib fractures. J Am Coll Radiol. 2019;16(5):227-234.
• 15. Harbert JC, George FH, Kerner ML. Differentiation of rib fractures from metastases by bone scanning. Clin Nucl Med.1981;6(8):359–61.
• 16. Capelastegui A, Oca R, Iglesias G. et al. MRI in suspected chest wall fractures: diagnostic value in work- related chest blunt trauma. Skeletal Radiol. 2024;53:275–83.
• 17. Lee RKL, Griffith JF, Ng AWH, Sitt JCM. Sonography of the Chest Wall: A Pictorial Essay. J Clin Ultrasound. 2015;43(9):525-37.
• 18. Turk F, Kurt AB, Saglam S. Evaluation by ultrasound of traumatic rib fractures missed by radiography. Emerg Radiol. 2010;17(6):473–7.
• 19. Bianchi S. Ultrasound and bone: a pictorial review. J Ultrasound. 2020;23(3):227-57.