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

摘要： 目的 分析肋骨骨折的临床诊断与法医学鉴定诊断非一致性的特点及其产生的原因，为此类案件的鉴定提供借鉴。方法 收集南通大学附属医院司法鉴定所于2019—2023年期间因道路交通事故外伤致肋骨骨折伤残程度鉴定案件268例，并进行回顾性分析，将伤后2周内、4~12周、13周~6个月、6个月~1年各时期的临床诊断与法医学诊断进行比较，结果采用卡方检验进行统计学分析。结果 与法医学诊断比较，早期（2周内）临床诊断非一致率达45.5%，伤后4~12周为21.6%，伤后13周~6个月为34.7%，伤后6个月~1年为41.3%；临床诊断与法医学诊断的差异在不同时期均有统计学意义（P<0.01），2周内非一致率最高，4~12周非一致率最低，2周内主要为漏诊，其总漏诊率较其他时间段最高，达40.6%，4~12周之后总误诊率逐渐增高，6个月~1年最高为31.2%。结论 肋骨骨折的临床诊断与法医学诊断存在较大差异，此类鉴定应尽可能收集完整的影像资料并对不同时期的影像数据进行动态观察，以作出准确判断。

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