What? Plain films mentioned last? Two view chest may be less radiation than a rib series. You do not need a lateral chest when looking for ribs. I am troubled by the newly trained CT dependent bias of your presenters. I have seen a normal CXR with blunt trauma in a skier who ultimately had FIVE displaced fractures. It is NOT controversial to get a rib series! You young bucks need to learn how to read them. That's what is controversial. It is easier than reading a chest CT. Goodness y'all.
Thank you so much Timothy for listening to Daily Dose and weighing in! This is a video review of a discussion where we highlighted OPTIONS for imaging and also some clinical decision tools that might help minimize CT imaging, thus we do not discredit anyone’s practice patterns. I don’t doubt that there are some specific spaces and cases where there might be utility in a rib series (esp in non trauma centers and resource limited environments), but evolving medicine and our body of literature changes that perspective from need (in days past) to can be considered for alternative diagnostic resources. Please feel free to check out Dr. Mason and Dr. Raja’s discussion on the options for imaging modalities in the setting of low mechanism trauma. Thanks again!
I think that one of the challenges with rib series is that they really have not been shown to change management in most cases. They are quite a bit better at identifying fractures than standard cxray but the ones that cxray misses and a rib series would catch likely does not change disposition for the patient. I think for most situations when your suspicion got that high you would go straight for a CT. Your case with the skier definitely seems like an outlier but I think that is the point of Nexus chest. It is trying to decide if patients should need advanced imaging at all.
I haven't read many rib series in my career but I have not seen many trauma colleagues reading them either honestly. I feel that in my own practice patients are split into a few categories: Patients with concerning injury pattern and exam that get the cxray and CT ordered together because the lieklihood of an injury needing management or intervention is moderate to high and the patients that are likely able to be discharged where sometimes the cxray shows a fracture and other times may not but if my suspicion is high I still explain to the patient there is likely a fracture here even though I don't see it myself. Would a rib series better identify that fracture, Yes I do think so but because that type of fracture identified in that scenario likely is not going to need a change in management I think that is why it has fallen a bit out of practice (myself included).
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Timothy P. - July 14, 2022 12:22 PM
What? Plain films mentioned last? Two view chest may be less radiation than a rib series. You do not need a lateral chest when looking for ribs. I am troubled by the newly trained CT dependent bias of your presenters. I have seen a normal CXR with blunt trauma in a skier who ultimately had FIVE displaced fractures. It is NOT controversial to get a rib series! You young bucks need to learn how to read them. That's what is controversial. It is easier than reading a chest CT.
Goodness y'all.
Whitney J. - July 14, 2022 9:16 PM
Thank you so much Timothy for listening to Daily Dose and weighing in! This is a video review of a discussion where we highlighted OPTIONS for imaging and also some clinical decision tools that might help minimize CT imaging, thus we do not discredit anyone’s practice patterns. I don’t doubt that there are some specific spaces and cases where there might be utility in a rib series (esp in non trauma centers and resource limited environments), but evolving medicine and our body of literature changes that perspective from need (in days past) to can be considered for alternative diagnostic resources. Please feel free to check out Dr. Mason and Dr. Raja’s discussion on the options for imaging modalities in the setting of low mechanism trauma. Thanks again!
Xian L. - July 14, 2022 9:28 PM
I think that one of the challenges with rib series is that they really have not been shown to change management in most cases. They are quite a bit better at identifying fractures than standard cxray but the ones that cxray misses and a rib series would catch likely does not change disposition for the patient. I think for most situations when your suspicion got that high you would go straight for a CT. Your case with the skier definitely seems like an outlier but I think that is the point of Nexus chest. It is trying to decide if patients should need advanced imaging at all.
I haven't read many rib series in my career but I have not seen many trauma colleagues reading them either honestly. I feel that in my own practice patients are split into a few categories: Patients with concerning injury pattern and exam that get the cxray and CT ordered together because the lieklihood of an injury needing management or intervention is moderate to high and the patients that are likely able to be discharged where sometimes the cxray shows a fracture and other times may not but if my suspicion is high I still explain to the patient there is likely a fracture here even though I don't see it myself. Would a rib series better identify that fracture, Yes I do think so but because that type of fracture identified in that scenario likely is not going to need a change in management I think that is why it has fallen a bit out of practice (myself included).