Point-of-Care Ultrasound for Suspected Rib Fractures in Blunt Thoracic Trauma: A Proposed Emergency Department Protocol

Blunt thoracic trauma accounts for substantial emergency department admissions, with rib fractures representing a predominant injury pattern.Undetected or inadequately characterised rib fractures exacerbate the risks of hypoventilation, atelectasis, secondary pneumonia, and delayed pleuropulmonary complications, particularly in older adults.Conventional initial diagnostic evaluation relies heavily on plain chest radiography, which exhibits recognised diagnostic insensitivity for undisplaced cortical breaches and injuries traversing the costochondral junctions.Although computed tomography provides definitive anatomical resolution, routine acquisition in stable, minor blunt trauma imposes ionising radiation burdens, emergency department delays, and escalating healthcare expenditures.Point-of-care ultrasound (POCUS) offers an accessible, radiation-free imaging adjunct possessing high sensitivity for superficial cortical breaches, chondral disruptions, and adjacent pleural complications.To address persistent diagnostic blind spots and documentation deficits in acute thoracic care, a structured emergency department POCUS workflow is proposed.The operational protocol integrates targeted high-frequency linear interrogation of symptomatic cortical margins, multi-zone transducer exclusion of pleural collections and pneumothorax, standardised sonographic criteria, and a structured clinical escalation algorithm.When integrated with comprehensive clinical assessment, this proposed POCUS protocol is intended to support acute trauma stratification, facilitate targeted regional anaesthesia, optimise clinical documentation, and complement conventional radiography in acute care environments.Prospective implementation studies are required to determine its diagnostic accuracy and impact on patient outcomes.