探讨咳嗽性胸痛在肋骨骨折中的诊断价值。

连续纳入2014年7月至2017年7月就诊于常州市武进人民医院急诊外科的单纯胸部外伤患者150例进行前瞻性队列研究，其中男性87例，女性63例；年龄20 ～ 72岁[(46.7±4.5)岁]。由急诊外科首诊医师完成病史询问和体格检查，确认患者在外伤早期是否存在咳嗽性胸痛；再对所有患者行胸部X线片、即刻(伤后24 h内)胸部计算机断层扫描(CT)平扫＋肋骨三维重建检查。4周后，所有患者通过复查胸部CT＋肋骨三维重建以明确肋骨骨折诊断。分别计数肋骨骨折确诊的阳性和阴性患者数，计算各筛选试验的灵敏度、特异度、阳性预测值、阴性预测值、阳性似然比、阴性似然比、约登指数及相应的95%置信区间(CI)，从而比较各筛选试验用于诊断胸部外伤后早期肋骨骨折的优劣。

14例患者失访，余136例患者中，85(62.5%)例患者经伤后4周的胸部CT平扫＋肋骨三维重建确诊为肋骨骨折。咳嗽性胸痛筛选试验的灵敏度为95.3%(95% CI 91.8%～99.8%)，特异度为58.8%(95% CI 45.3%～72.3%)，阳性预测值为88%(95% CI 81.3%～94.7%)，阴性预测值为68.2%(95% CI 54.4%～82.0%)，阳性似然比为2.31(95% CI 1.80～2.97)，阴性似然比为0.08(0.04～0.17)。与胸部X线片和即刻胸部CT＋肋骨三维重建检查相比，咳嗽性胸痛诊断肋骨骨折具有更高的敏感度，但约登指数略低于CT。

以咳嗽性胸痛作为肋骨骨折的诊断依据之一，有助于首诊医师对胸部外伤患者的病情进行初步评估。

To investigate the diagnostic value of cough pain in rib fracture.

150 cases of consecutive patients with chest trauma treated in the emergency surgery were enrolled in this prospective cohort study, of which 14 cases were lost. Firstly, ask whether there were cough pain and then take chest X-ray, CT+ scan and three-dimensional reconstruction of the rib. Finally, reexamine the rib CT+ 3D reconstruction of four weeks.The final diagnosis is the results of the rib CT+ 3D reconstruction after four weeks.

In 136 patients, 85 patients were diagnosed as rib fractures, among whom 81 cases have cough symptoms of chest pain. The sensitivity was 95.3% (95% CI, 91.8% to 99.8%). The specificity was 58.8% (95% CI, 45.3% to 72.3%). The positive predictive value was 88% (95% CI, 81.3% to 94.7%). The negative predictive value was 68.2% (95% CI, 54.4% to 82.0%). The positive likelihood ratio was 2.31 (95% CI, 1.80 to 2.97). The negative likelihood ratio was 0.08 (95% CI, 0.04 to 0.17). Chest pain has a higher sensitivity when compared with chest X-ray and immediate rib CT examination.

chest pain during coughing is one of the evidences for the diagnosis of rib fracture. It is helpful for the first visit doctor to make a preliminary evaluation of the patient’s condition, early intervention, and to reduce the incidence of complications.