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LetterCorrespondence

Re: One-View Chest Radiograph for Initial Management of Most Ambulatory Patients With Rib Pain

Lia Zumblick and Chaiana Esmeraldino Mendes Marcon
The Journal of the American Board of Family Medicine July 2021, 34 (4) 878; DOI: https://doi.org/10.3122/jabfm.2021.04.210082
Lia Zumblick
University of Southern Santa Catarina, Rua Recife, 498, Tubarão, SC, Brasil
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  • For correspondence: liazumblick@gmail.com
Chaiana Esmeraldino Mendes Marcon
PhD
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To the Editor: We read with interest the article from Nishimura and colleagues, who proposed that the use of posteroanterior (PA) chest radiograph is sufficient to assess patients with a suspected rib fracture, with no need for a rib series. The article also provides the information that ultrasound has been shown to be a sensitive method for detecting rib fractures.1

While praising her work, I would like to add some information in the discussion surrounding the use of lung ultrasound. Lung ultrasound has become an important tool in the extension of the physical examination, and thus, a great ally for clinicians. The use of radiation must follow the ALARA principle, defined as being “as low as reasonably achievable.” In this context, there is a preference for modalities that do not require radiation, such as ultrasound.2

Another advantage of ultrasound is its cost, being more economically profitable and readily available. An ultrasound allows a faster diagnosis because it can be performed in the physician's office without the need of going to the radiology department.1 Besides, the use of contrast and sedation is not necessary.3

Many studies have been conducted comparing whether lung ultrasound is superior in accuracy to chest radiography in diagnosing rib fractures following blunt chest wall trauma. These studies have shown that the use of lung ultrasound seems superior compared with a chest radiograph.4

However, all studies were small, single-center, and considered at risk of bias on quality assessment, demonstrating the need to reapply more studies in this area since the benefit it would bring to the patient is undeniable.

Notes

  • Conflict of interest: None.

  • Funding: None.

  • To see this article online, please go to: http://jabfm.org/content/34/4/878.full.

References

  1. 1.↵
    1. Nishimura E,
    2. Finger A,
    3. Harris M,
    4. Yoon HC
    . One-view chest radiograph for initial management of most ambulatory patients with rib pain. J Am Board Fam Med 2021;34:144–150.
    OpenUrlAbstract/FREE Full Text
  2. 2.↵
    1. Radzina M,
    2. Biederer J
    . Ultrasonography of the lung. Rofo 2019;191:909–923.
    OpenUrl
  3. 3.↵
    1. Joshi P,
    2. Vasishta A,
    3. Gupta M
    . Ultrasound of the pediatric chest. Br J Radiol 2019;92:20190058.
    OpenUrl
  4. 4.↵
    1. Battle C,
    2. Hayward S,
    3. Eggert S,
    4. et al
    . Comparison of the use of lung ultrasound and chest radiography in the diagnosis of rib fractures: a systematic review. EMJ 2019;36:185–190.
    OpenUrlAbstract/FREE Full Text
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The Journal of the American Board of Family     Medicine: 34 (4)
The Journal of the American Board of Family Medicine
Vol. 34, Issue 4
July/August 2021
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Re: One-View Chest Radiograph for Initial Management of Most Ambulatory Patients With Rib Pain
Lia Zumblick, Chaiana Esmeraldino Mendes Marcon
The Journal of the American Board of Family Medicine Jul 2021, 34 (4) 878; DOI: 10.3122/jabfm.2021.04.210082

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Re: One-View Chest Radiograph for Initial Management of Most Ambulatory Patients With Rib Pain
Lia Zumblick, Chaiana Esmeraldino Mendes Marcon
The Journal of the American Board of Family Medicine Jul 2021, 34 (4) 878; DOI: 10.3122/jabfm.2021.04.210082
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