Ces radiol. 2018, 72(1):7-12 | DOI: 10.55095/CesRadiol2018/001

Diagnostic accuracy of x-ray in skeletal chest injuries following cardiopulmonary resuscitationOriginal article

Marek Vinkler¹, Zbyněk Tüdös¹, Filip Čtvrtlík¹, Zuzana Sedláčková¹, Bronislav Klementa², Olga Klementová²

¹ Radiologická klinika LF UP, Olomouc

² Klinika anesteziologie, resuscitace a intenzivní medicíny LF UP a FN

Aim: Cardiopulmonary resuscitation (CPR) is a lifesaving act, however, it can also lead to chest injuries due to thoracic compression. The most frequent injuries are fractures of ribs and the sternum. Our purpose was to determine the sensitivity of the plain chest radiography (CXR) to reveal rib fractures after CPR.

Methods: Retrospective analysis of 490 patients who underwent the cardiopulmonary resuscitation from 2011 to 2015. We focused on patients with post-procedure CXR or CT available. Experienced radiologists searched for rib fractures after CPR. We also graded the technical quality of the CXR on a 10-point scale.

Results: Imaging studies of the thorax were available in 128 patients, all of them had the CXR and CT scans were available in 27 patients. Only two CXRs showed the rib fractures that could be attributed to CPR. CT scans were much more sensitive. The positive CT finding was present in 10 patients (51 rib fractures in total). There was only one fracture fully correlated between CXR and CT. All the fractures were localized in the ventral third of ribs. Average image quality reached 6.06 points out of 10. In 61 cases, there was additional pathology (e.g. pleural fluid or parenchyma consolidation) potentially obscuring skeletal finding.

Conclusion: Sensitivity of CXR to prove rib fractures after CPR is low. One of the reasons is the localization of fractures in the ventral portion of the rib, another is the serious clinical state of patients leading to worse image quality and also additional thoracic pathologies. CT scan seems to be appropriate tool to prove the injuries after CPR.

Keywords: cardiopulmonary resuscitation, chest injuries, chest x-ray, computed tomography, rib fractures, sternum

Grants and funding:

Práce byla podpořena grantem UP: IGA_LF_2017_001 a RVO: LF UP 61989592.

Accepted: February 15, 2018; Published: March 1, 2018  Show citation