关键词: 法医临床学, 肋骨骨折, 法医学诊断, 临床诊断, 案例分析

Abstract: Objective To analyze the characteristics and causes of inconsistencies between clinical diagnosis and forensic diagnosis of rib fractures, so as to provide reference for the identification of such cases. Methods A retrospective analysis was conducted on 268 cases of rib fractures and disability assessment caused by road traffic accident injuries evaluated at the Institute of Forensic Science, Affiliated Hospital of Nantong University from 2019 to 2023. Clinical diagnosis and forensic diagnosis were compared in different periods of ≤2 weeks, 4 to 12 weeks, 13 weeks to   6 months, and 6 months to 1 year after injury. The results were statistically analyzed using chi-square test. Results Compared with forensic diagnosis, the inconsistency of early (within 2 weeks) clinical diagnosis reached 45.5%, 21.6% at 4-12 weeks after injury, 34.7% at 13 weeks to 6 months after injury, and 41.3% at 6 months to 1 year after injury. The differences between clinical diagnosis and forensic diagnosis are all statistically significant at different stages  (P<0.01), with the highest inconsistency rate within 2 weeks and the lowest inconsistency rate at 4-12 weeks. Within 2 weeks, the main cause of the inconsistency is missed diagnosis, with a total rate of 40.6%, which is the highest compared to other time periods. After 4-12 weeks, the total missed diagnosis rate gradually increases, reaching a maximum of 31.2% between 6 months to 1 year. Conclusion There are great differences between the clinical diagnosis and the forensic diagnosis of rib fractures. The identification process should incorporate comprehensive imaging data and dynamic multi-temporal observations to ensure accurate judgments.

Key words: forensic clinical medicine, rib fracture, forensic diagnosis, clinical diagnosis, case analysis