{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T19:03:08Z","timestamp":1780340588383,"version":"3.54.1"},"reference-count":23,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2018,5,25]],"date-time":"2018-05-25T00:00:00Z","timestamp":1527206400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","award":["RO\u20101 1 R01\/CE001589\u201001"],"award-info":[{"award-number":["RO\u20101 1 R01\/CE001589\u201001"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2018,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Scapular fractures have been traditionally taught to be associated with significant injuries and major morbidity. As we demonstrated with sternal fracture, pulmonary contusion, and rib fracture, increased chest computed tomography (<jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content>) utilization and head\u2010to\u2010pelvis <jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content> (pan\u2010scan) protocols in blunt trauma evaluation, however, may diagnose minor, clinically irrelevant scapular fractures, possibly rendering previous teachings obsolete.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>The objectives were to determine the 1) percentages of scapular fractures seen on chest <jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content> only (<jats:styled-content style=\"fixed-case\">SOCTO<\/jats:styled-content>) versus seen on both chest x\u2010ray (<jats:styled-content style=\"fixed-case\">CXR<\/jats:styled-content>) and <jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content> and of isolated scapular fracture (scapular fracture without other thoracic injuries); 2) frequencies of associated thoracic injury with scapular fracture; and 3) proportion of patients admitted, mortality, hospital length of stay, and injury severity scores (<jats:styled-content style=\"fixed-case\">ISS<\/jats:styled-content>), comparing four patient groups: scapular fracture, nonscapular fracture, scapular fracture <jats:styled-content style=\"fixed-case\">SOCTO<\/jats:styled-content>, and isolated scapular fracture.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a preplanned analysis of patients prospectively enrolled in the <jats:styled-content style=\"fixed-case\">NEXUS<\/jats:styled-content> Chest <jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content> study at nine Level I trauma centers with the following inclusion criteria: age\u00a0&gt;\u00a014 years, blunt trauma within 6 hours of <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> presentation, and receiving chest imaging during <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> trauma evaluation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 11,477 subjects, 4,501 (39.2%) patients who had both <jats:styled-content style=\"fixed-case\">CXR<\/jats:styled-content> and chest <jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content> and 2.7% of these had scapular fractures; 60.3% of these were <jats:styled-content style=\"fixed-case\">SOCTO<\/jats:styled-content> and 23 (19.0%) were isolated scapular fracture. The most commonly associated thoracic injuries were rib fracture, pulmonary contusion, pneumothorax, and thoracic spine fracture and all injuries were more common in scapular fracture patients than nonscapular fracture patients. Although scapular fracture patients had higher admission rates (86.8% vs. 47.4%; difference in proportions\u00a0= 39.4% [95% confidence interval {<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>}\u00a0= 32.8% to 44.1%]), <jats:styled-content style=\"fixed-case\">ISS<\/jats:styled-content> (21 vs. 5), and length of stay (9.2 days vs. 5.6 days; mean difference\u00a0= 3.4 days [95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\u00a0= 2.1 to 4.7 days]) than patients without scapular fracture, their hospital mortality was not significantly different (5.6% vs. 3.0%; difference in proportions\u00a0= 2.6% [95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\u00a0= \u20138.2% to 0.3%]; unadjusted odds ratio\u00a0= 1.9 [95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\u00a0= 0.9 to 4.2]). Patients with scapular fracture <jats:styled-content style=\"fixed-case\">SOCTO<\/jats:styled-content> and isolated scapular fracture had higher admission rates and median <jats:styled-content style=\"fixed-case\">ISS<\/jats:styled-content> than nonscapular fracture patients, but their mortality was similar.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Under current blunt trauma imaging protocols that commonly include chest <jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content>, most scapular fractures are <jats:styled-content style=\"fixed-case\">SOCTO<\/jats:styled-content> and most are associated with other thoracic injuries. Although patients with scapular fracture <jats:styled-content style=\"fixed-case\">SOCTO<\/jats:styled-content> and isolated scapular fracture have higher admission rates and <jats:styled-content style=\"fixed-case\">ISS<\/jats:styled-content> than nonscapular fracture patients, their hospital mortality is similar.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acem.13377","type":"journal-article","created":{"date-parts":[[2018,1,11]],"date-time":"2018-01-11T07:48:03Z","timestamp":1515656883000},"page":"738-743","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Scapular Fractures in the Pan\u2010scan Era"],"prefix":"10.1111","volume":"25","author":[{"given":"Cortlyn","family":"Brown","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine The University of California San Francisco San Francisco 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