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Comparison of the use of lung ultrasound and chest radiography in the diagnosis of rib fractures: a systematic review
  1. Ceri Battle1,
  2. Simon Hayward2,
  3. Sabine Eggert3,
  4. Phillip Adrian Evans1
  1. 1 Welsh Centre in Emergency Medicine Research, Morriston Hospital, Swansea, UK
  2. 2 Physiotherapy Department, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
  3. 3 Ed Major Critical Care Unit, Morriston Hospital, Swansea, UK
  1. Correspondence to Dr Ceri Battle, Welsh Centre in Emergency Medicine Research, Morriston Hospital, Swansea SA6 6NL, UK; ceri.battle{at}


Introduction It is well-recognised that the detection of rib fractures is unreliable using chest radiograph. The aim of this systematic review was to investigate whether the use of lung ultrasound is superior in accuracy to chest radiography, in the diagnosis of rib fractures following blunt chest wall trauma.

Methods The search filter was used for international online electronic databases including MEDLINE, EMBASE, Cochrane and ScienceDirect, with no imposed time or language limitations. Grey literature was searched. Two review authors completed study selection, data extraction and data synthesis/analysis process. Quality assessment using the Quality Assessment of Diagnostic Accuracy Studies Tool (QUADAS-2) was completed.

Results 13 studies were included. Overall, study results demonstrated that the use of lung ultrasound in the diagnosis of rib fractures in blunt chest wall trauma patients appears superior compared with chest radiograph. All studies were small, single centre and considered to be at risk of bias on quality assessment. Meta-analysis was not possible due to high levels of heterogeneity, lack of appropriate reference standard and poor study quality.

Discussion The results demonstrate that lung ultrasound may be superior to chest radiography, but the low quality of the studies means that no definitive statement can be made.

  • trauma, chest
  • ultrasound
  • x-ray
  • diagnosis

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  • Contributors All authors contributed to the conception and design of the study. CB, SH and PAE completed the data acquisition, analysis and interpretation. SE interpreted the foreign language papers. CB drafted the work and SH, PAE and SE revised it critically for important intellectual content. All authors have approved the version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.