When Should Abdominal Computed Tomography Be Considered in Patients With Lower Rib Fractures?

Igor Jeroukhimov, MD; Yehuda Hershkovitz, MD; Itay Wiser, MD, PHD; Boris Kessel, MD; Mohammed Ayyad, MD; Inbar Gatot, MD; Zahar Shapira, MD; Svetlana Jeoravlev, RN; Ariel Halevy, MD; Ron Lavy, MD


J Emerg Med. 2017;52(5):609-614. 

In This Article

Abstract and Introduction


Background: Lower rib fractures are considered as a marker of intra-abdominal organ injury. Abdominal computed tomography (CT) is the "gold standard" examination for patients with lower rib fractures. However, the reported incidence of concomitant intra-abdominal injuries (IAI) is 20%–40%.

Objective: The purpose of this study was to evaluate the incidence of intra-abdominal organ injuries in blunt trauma patients with lower rib fractures.

Methods: Medical charts and radiology reports of patients with lower rib (from the 8th to 12th rib) fractures admitted to our center during a 6-year period were retrospectively reviewed. Patients were divided into two groups. Group I included patients with intra-abdominal injury (IAI) diagnosed either by CT or on urgent laparotomy, and Group II included those with normal abdominal CT scans. Data included demographics, mechanism of injury, laboratory tests, radiology results including number and location of fractured ribs, and incidence of IAI.

Results: Overall 318 patients were included in the study. Fifty-seven patients (17.9%) had 71 IAIs compared with 265 (82.1%) patients with no IAI. Logistic regression identified age younger than 55 years (relative risk [RR] = 7.2; 95% confidence interval [CI] 3.1–16.8; p = 0.001), bilateral rib fractures (RR = 3.9; 95% CI 1.1–13.5; p = 0.03) and decreased levels of hematocrit (RR = 2.4; 95% CI 1.2–4.8; p = 0.016) as independent risk factors for the presence of IAI.

Conclusions: Abdominal CT should be considered in blunt trauma patients with lower rib fractures who are younger than 55 years of age and have bilateral rib fractures and decreased levels of hematocrit on admission.


Concomitant intra-abdominal injury (IAI) is diagnosed in 20%–40% of blunt trauma patients with lower rib fractures.[1,2] Computed tomography (CT) is the preferable imaging modality in the evaluation of stable blunt trauma patient with lower rib fractures. Although CT can help to rule out concomitant IAI, it carries a risk of ionizing radiation.[3,4] Currently, not every patient with lower rib fractures undergoes abdominal CT. The true incidence of IAI in these patients remains unclear.

The purpose of this study was to describe the incidence of IAI in trauma patients with lower rib fractures, together with an analysis of clinical, laboratory, and imaging-associated characteristics within different subgroups that may help to identify patients with IAI.