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The following is a summary of the systematic review findings up to the date of our most recent literature search. If you have a specific clinical case, we strongly recommend you read all of the relevant references as cited and look for additional material published outside our search dates.


  • Of 540 studies reviewed, 13 addressed whether cardiopulmonary resuscitation (CPR) caused rib fractures 1-13
  • Study design:
    • 1 case-control 9
    • 4 cross-sectional 1,3,11,12
    • 8 case series 2,4-8,10,13
  • Total data: over 1500 children
  • Age range: 0-18 years
  • Gender: data not analysed by gender
  • No study addressed CPR related rib fractures in disabled children
  • Influence of ethnicity and socio-economic group: not addressed by these included studies

 N.B. references 14 & 15 are related to reference 10

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  1. Betz P, Liebhardt E. Rib fractures in children - resuscitation or child abuse? International Journal of Legal Medicine. 1994;106(4):215-218 [Pubmed]
  2. Boz B, Erdur B, Acar K, Ergin A, Turkcuer I, Ergin N. [Frequency of skeletal chest injuries associated with cardiopulmonary resuscitation: forensic autopsy]. [Turkish]. Ulusal Travma ve Acil Cerrahi Dergisi [Turkish Journal of Trauma & Emergency Surgery]. 2008;14(3):216-220 [Pubmed]
  3. Bush CM, Jones JS, Cohle SD, Johnson H. Pediatric injuries from cardiopulmonary resuscitation. Annals of Emergency Medicine. 1996;28(1):40-44 [Pubmed]
  4. Cosway B, Mathura N, Mott A, Bredow M, Fraser J, Rawlinson A, Wei C, Thyagarajan M, Harrison S, Kemp A. Occult rib fractures: Defining the cause. Child Abuse Review. 2013. [Early View - Abstract available from Wiley online library]

  5. Feldman KW, Brewer DK. Child abuse, cardiopulmonary resuscitation, and rib fractures. Pediatrics. 1984;73(3):339-342 [Pubmed]
  6. Lin YR, Li CJ, Wu TK, Chang YJ, Lai SC, Liu TA, Hsiao MH, Chou CC, Chang CF. Post-resuscitative clinical features in the first hour after achieving sustained ROSC predict the duration of survival in children with non-traumatic out-of-hospital cardiac arrest. Resuscitation. 2010;81(4):410-417 [Pubmed]
  7. Matshes EW, Lew EO. Do Resuscitation-Related Injuries Kill Infants and Children? American Journal of Forensic Medicine and Pathology. 2010;31(2):178-185 [Pubmed]
  8. Matshes EW, Lew EO. Two-handed cardiopulmonary resuscitation can cause rib fractures in infants. American Journal of Forensic Medicine and Pathology. 2010;31(4):303-307 [Pubmed]
  9. Price EA, Rush LR, Perper JA, Bell MD. Cardiopulmonary resuscitation-related injuries and homicidal blunt abdominal trauma in children. The American Journal of Forensic Medicine and Pathology. 2000;21(4):307-310 [Pubmed]
  10. Reyes JA, Somers GR, Taylor GP, Chiasson DA. Increased incidence of CPR-related rib fractures in infants - is it related to changes in CPR technique? Resuscitation. 2011;82(5):545-548 [Pubmed]
  11. Ryan MP, Young SJ, Wells DL. Do resuscitation attempts in children who die, cause injury? Emergency Medicine Journal. 2003;20(1):10-12 [Pubmed]
  12. Spevak MR, Kleinman PK, Belanger PL, Primack C, Richmond JM. Cardiopulmonary resuscitation and rib fractures in infants. A postmortem radiologic-pathologic study. The Journal of the American Medical Association. 1994;272(8):617-618 [Pubmed]
  13. Weber MA, Risdon RA, Offiah AC, Malone M, Sebire NJ. Rib fractures identified at post-mortem examination in sudden unexpected deaths in infancy (SUDI). Forensic Science International. 2009;189(1-3):75-81 [Pubmed]
  14. Martin, P. S.;Jones, M. D.;Maguire, S. A.;Theobald, P. S.;Kemp, A. M. Increased incidence of CPR-related rib fractures in infants - Is it related to changes in CPR technique? Resuscitation. 2012;83(4):E109-E109 [Pubmed]

  15. Reyes, J. A.;Somers, G. R.;Taylor, G. P.;Chiasson, D. A. Response to Letter: Increased incidence of CPR-related rib fractures in infants - Is it related to changes in CPR technique? Resuscitation.2012;83(4):E111-E111 [Abstract available from Science Direct]


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