Rib fracture diagnosis in suspected abuse: computed tomography or radiographs (RECEPTOR)? A multicentre diagnostic accuracy observational study

OBJECTIVES: To assess the diagnostic accuracy of chest CT for rib fractures in live children investigated for suspected physical abuse (SPA), using initial and follow-up chest radiographs (CXRs) as the reference standard.

MATERIALS AND METHODS: A retrospective 10-year (September 2011-2021) multicentre search was performed for children less than two years of age who received CXRs and chest CT for SPA. Nineteen consultant radiologists independently read the images: Round 1 (initial CXRs only), Round 2 (CTs only) and Round 3 (initial and follow-up CXRs). No reporter performed Round 3 before Round 1 or 2. Radiologists reported the presence of rib fractures, fracture age, fracture location and confidence level. CT diagnostic accuracy (sensitivity, specificity, and accuracy) was calculated per patient, per rib and per specific location along the rib arc.

RESULTS: A total of 64 patients (36 boys) with a median age of 2 months were included and assessed by 19 independent consultant radiologists. Patient level analysis: CT sensitivity = 90.6% (95% confidence interval [CI]: 88.2-92.6), specificity = 74.2% (95% CI: 70.2-78.0). Rib level analysis: CT sensitivity = 85.6% (95% CI: 84.1-87.0), specificity = 94.16% (95% CI: 93.8-94.4). Location level analysis: CT sensitivity = 75.7% (95% CI: 74.0-77.4), specificity = 97.09% (95% CI: 96.9-97.2).

CONCLUSION: Chest CT confers accurate rib fracture detection in live children with SPA, with the potential to replace the current standard of performing six CXRs as part of initial and follow-up imaging for SPA.

KEY POINTS: Question What is the diagnostic performance of chest CT in detecting rib fractures in live children with SPA, using CXR as a reference standard? Findings Chest CT showed 90.6% sensitivity and 74.2% specificity for detecting rib fractures on patient-based analysis, with 79.7% sensitivity for posterior rib fractures. Clinical relevance Chest CT accurately detects rib fractures in children investigated for SPA and may serve as an alternative to initial and follow-up CXR, supporting timely clinical assessment and management.