Beyond the break: development and validation of a new classification system for acute traumatic rib fractures.

Abstract

Background: Despite the high incidence and significant injury burden of rib fractures, a universally agreed-upon taxonomy for acute traumatic rib fractures (TARF) has not been established. We propose a novel TARF with three components: (1) the rib that is fractured, (2) the anatomic sector of the fracture, and (3) the fracture severity. We hypothesized that each of these components can be interpreted on chest CT by radiologists and trauma surgeons with acceptable interobserver agreement (IOA), providing a consistent method for describing traumatic rib fractures.

Methods: Between August and November 2020, 100 patients with reported rib fractures from our Level 1 trauma database were randomly selected for study inclusion. Two lead surgeons created a key map on specific fracture variable data on chest CT. Four surgeons, one chief surgical resident, and one radiologist completed the interpretation of 50 CT images (Set 1). Each physician was provided feedback and asked to verify and interpret a second set of 50 CT chest scans (Set 2) to determine the final IOA.

Results: The baseline IOA between the lead surgeons on Set 2 was 86.3%. The radiologist scored 83.9% agreement on Set 1 and was excluded from further review. Four surgeons and one chief resident had a mean IOA of 41.9% for Set 1. Subsequently, they had a mean IOA of 72% on Set 2.

Conclusions: Our experience suggests that this taxonomy can be used among surgical and radiology experts to better describe the true rib fracture burden, allowing for highly detailed information in a concise clinically relevant format. Furthermore, this TARF may allow for optimal comparison of patients with rib fractures and potentially provide improved insight into fracture patterns and patient outcomes with or without surgical rib fixation. Further investigations utilizing this TARF are needed.

Level of evidence: IV.