RCR National Audit Evaluating the Radiological Reporting of Fragility Fractures.

Congress:

ECR 2020

Poster Number:

C-09123

Type:

Scientific Exhibit

Keywords:

Musculoskeletal, Bones, Musculoskeletal spine, CT, Observer performance, Screening, Structured reporting, Osteoporosis, Retrospective, Not applicable, Multicentre study

Authors:

N. Mahmood¹, C. Law², K. Drinkwater³, J. Illes⁴, J. Griffin³, K. Javaid⁵, D. Howlett⁶; ¹Sussex /UK, ²East Sussex/UK, ³London/UK, ⁴Dorset/UK, ⁵Oxford/UK, ⁶Eastbourne/UK

DOI:

10.26044/ecr2020/C-09123

DOI-Link:

https://dx.doi.org/10.26044/ecr2020/C-09123

$Fig. 1: Vertebral fragility fracture depicted.$

Fig. 1: Vertebral fragility fracture depicted.

$Fig. 2: Image 2: The Genant semiquantitative scale, one of the vertebral fracture assessment tools, is classified into 4 grades according to the degree of collapse$

Fig. 2: Image 2: The Genant semiquantitative scale, one of the vertebral fracture...

Table 1: Table 1: Compliance with ROS audit standards.

Table 2: Table 2: Presence of VFF's on auditor review and sagittal reformats of the...

Purpose

Vertebral fragility fractures (VFF’s) are a common type of osteoporotic fracture and can be a significant cause of morbidity, increased chronic pain and decreased quality of life in older patients. Patients with such fractures are also at higher risk of hip fractures if not appropriately treated, which contributes significant morbidity and mortality in this population1,2. Radiologists play a key role in identifying and diagnosing these incidentally. However multiple studies have shown that VFF’s are under-reported despite being clearly identifiable on CT. This may be because...

Methods and materials

For this audit, the Royal College of radiologists (RCR) collaborated with the Royal College of Physicians (RCP) and Royal Osteoporosis Society (ROS). Radiology department audit leads across the UK were invited to participate and send audit data to the RCR on behalf of their department. The audit leads were sent an instruction book and two questionnaires which comprised the following: 1) First, an online questionnaire about the department to be completed by audit lead. This was to assess the reporting infrastructure and referral pathways. 2)...

Results

The overall response rate was 63% (127/ 217 eligible departments with data received from 6307 patients. Compliance with audit standards is demonstrated in Table 1. VFF’s were incidentally present on 21% of scans (1344/6307) reviewed by the auditor. Of these 611 patients had a fracture mentioned in the primary report (45%). In these 611 patients the initial report use the term ‘vertebral fracture’ in only 60% and the severity was graded in only 21%. Where sagittal reformats were available, bone integrity was more likely to...

Conclusion

This large retrospective UK-wide national audit confirms vertebral fragility fracture are often either underreported or misreported, there is failure of compliance with key audit standards, and there is little consistency in grading fracture severity. This is likely to reflect practice across European radiology departments. Increased awareness and clear reporting is necessary for this group of patients to receive appropriate treatment.

Personal information and conflict of interest

N. Mahmood,C. Law,K. Drinkwater, J. Illes, J. Griffin,K. Javaid,D. Howlett. With thanks to the RCR, RCP and ROS for their collaboration.

References

[1] Kanis JA, Johnell O, Oden A et al. Long-term risk of osteoporotic fracture in Malmö.Osteoporos Int.2000;11(8):669-74 [2] Samelson EJ, Hannan MT, Zhang Y et al. Incidence and risk factors for vertebral fracture in women and men: 25-year follow-up results from the population-based Framingham study. JBone Miner Res.2006;21(8):1207-14.