Radiology Reporting of Vertebral Fragility Fractures in Pilgrim Hospital, Boston: Preview of a National Audit Kushal Joshi, University Hospitals of Leicester Tauseef Ashraf, Pilgrim Hospital, Boston Introduction Vertebral fragility fractures are the most common osteoporotic fracture causing significant morbidity and deterioration in quality of life in elderly patients. 1,2 Unfortunately, up to 70% of these fractures remain undiagnosed with only 46% reported. 3,4 Radiologists can play a crucial role in identifying them which, when treated, can reduce further fractures and positively impact the patient’s quality of life. 5 In this audit, we evaluate the reporting of 200 cases performed at Pilgrim Hospital, Boston and provide a preview of what can be expected when RCR's national audit on this subject is completed. Standards Derived from National Osteoporosis Society Clinical Guidance for the Effective Identification of Vertebral Fractures. Target 1. 100% of reports to comment on the thoracolumbar spine. 2. 100% of moderate to severe vertebral fractures to be identified. 3. 100% of identified fractures to be reported unambiguously. 4. 100% of identified fractures to make appropriate recommendations for further assessment. Methodology 200 consecutive CT Chest Abdomen and Pelvis in patients aged >70 were included. Cases of trauma, known bone metastases or myeloma were excluded. Spine assessed in sagittal reformats using semi-quantitative method (Genant et al.) 6 Results of 1 st audit round Examples of Unreported Fractures Mild Moderate Severe Multilevel Severe Standard Target Achieved Proportion of scans in which the reporting radiologist has commented on the thoracic and/or lumbar spine appearance 100% 25% 95.5% had comment on the bones in general. Proportion of scans in which moderate/severe vertebral fractures are correctly identified on the report >95% 47.8 % (11 out of 23 cases) Proportion of vertebral fractures reported using correct terminology (i.e. “vertebral fracture” 100% 63.6% (7 out of 11 identified cases) Proportion of patients with vertebral fractures in which the report contains appropriate recommendations for further assessment 100% 0% 1 st Action Plan Results were presented at the departmental discrepancy meeting. Attitudes towards osteoporotic fractures and perceived barriers to reporting them were discussed. Information was also disseminated to the tele-radiology service provider. Recommendations to Radiologists 1. Encourage clear wording to ensure spine has been assessed. 2. Report on moderate to severe vertebral body fractures 3. Report unambiguously using the word fracture 4. Raise possibility of osteoporosis. Appearances suggest osteoporosis. Further investigation and management to reduce the risk of further fracture is advised. 2 nd Audit Round Data collection is ongoing. References 1. O’Neill TW, Felsenberg D, Varlow J, Cooper C, Kanis JA, Silman J. The prevalence of vertebral deformity in European men and women: the European Vertebral Osteoporosis Study. J Bone Miner Res. 1996;11:1010-18. 2. Al-Sari U, Tobias J, Clark E. Health related quality of life in older people with osteoporotic vertebral fractures: a systematic review and meta-analysis. Osteoporosis Int. 2016;27(10),2891-909. 3. Cooper C, Atkinson EJ, O’Fallen WM, Melton LJ 3rd. Incidence of clinically diagnosed vertebral fractures: a populationbased study in Rochester, Minnesota. J Bone Miner Res. 1992;7:221-7. 4. Mitchell RM, Jewell P, Javaid MK, McKean D, Ostlere SJ. Reporting of vertebral fragility fractures: can radiologists help reduce the number of hip fractures? Arc Osteoporosis. 2017;12(1):71. 5. Freemantle N, Cooper C, Diez-Perez A, Gitlin M, Radcliffe H, Shepherd S, et al. Results of indirect and mixed treatment comparison of fracture efficacy for osteoporosis treatments: a meta-analysis. Osteoporosis Int. 2013;24(1):209-17. 6. Genant HK, Wu CY, van Kuijik C, Nevitt MC. Vertebral fracture assessment using a semi-quantitative technique JBMR. 1993;8(9):1137-48.

Radiology Reporting of Vertebral Fragility Fractures in Pilgrim … · 2019. 9. 18. · Derived from National Osteoporosis Society Clinical Guidance for the Effective Identification

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Page 1: Radiology Reporting of Vertebral Fragility Fractures in Pilgrim … · 2019. 9. 18. · Derived from National Osteoporosis Society Clinical Guidance for the Effective Identification

RadiologyReportingofVertebralFragilityFracturesinPilgrimHospital,Boston:PreviewofaNationalAuditKushal Joshi,UniversityHospitalsofLeicester

Tauseef Ashraf,PilgrimHospital,Boston

Introduction

Vertebralfragilityfracturesarethemostcommonosteoporoticfracturecausingsignificantmorbidityanddeteriorationinqualityoflifeinelderlypatients.1,2Unfortunately,upto70%ofthesefracturesremainundiagnosedwithonly46%reported.3,4Radiologistscanplayacrucialroleinidentifyingthemwhich,whentreated,canreducefurtherfracturesandpositivelyimpactthepatient’squalityoflife.5 Inthisaudit,weevaluatethereportingof200casesperformedatPilgrimHospital,BostonandprovideapreviewofwhatcanbeexpectedwhenRCR'snationalauditonthissubjectiscompleted.

Standards

DerivedfromNationalOsteoporosisSocietyClinicalGuidancefortheEffectiveIdentificationofVertebralFractures.

Target

1. 100%ofreportstocommentonthethoracolumbarspine.2. 100%ofmoderatetoseverevertebralfracturestobeidentified.3. 100%ofidentifiedfracturestobereportedunambiguously.4. 100%ofidentifiedfracturestomakeappropriaterecommendationsfor

furtherassessment.

Methodology

200consecutiveCTChestAbdomenandPelvisinpatientsaged>70wereincluded.Casesoftrauma,knownbonemetastasesormyelomawereexcluded.Spineassessedinsagittalreformatsusingsemi-quantitativemethod(Genant etal.) 6

Resultsof1st auditround

ExamplesofUnreportedFractures

MildModerateSevereMultilevelSevere

Standard Target AchievedProportionofscansinwhichthereportingradiologisthascommentedonthethoracicand/orlumbarspineappearance

100% 25%

95.5%hadcommentonthebonesingeneral.

Proportionofscansinwhichmoderate/severevertebralfracturesarecorrectlyidentifiedonthereport

>95% 47.8%(11outof23cases)

Proportionofvertebralfracturesreportedusingcorrectterminology(i.e.“vertebralfracture”

100% 63.6%(7 outof11identifiedcases)

Proportionofpatientswithvertebralfracturesinwhichthereportcontainsappropriaterecommendationsforfurtherassessment

100% 0%

1st ActionPlan

Resultswerepresentedatthedepartmentaldiscrepancymeeting.Attitudestowardsosteoporoticfracturesandperceivedbarrierstoreportingthemwerediscussed.Informationwasalsodisseminatedtothetele-radiologyserviceprovider.

RecommendationstoRadiologists

1. Encourageclearwordingtoensurespinehasbeenassessed.2. Reportonmoderatetoseverevertebralbodyfractures3. Reportunambiguouslyusingthewordfracture4. Raisepossibilityofosteoporosis.

Appearancessuggestosteoporosis.Furtherinvestigationandmanagementtoreducetheriskoffurtherfractureisadvised.

2nd AuditRound

Datacollectionisongoing.

References

1. O’NeillTW,Felsenberg D,Varlow J,CooperC,Kanis JA,Silman J.TheprevalenceofvertebraldeformityinEuropeanmenandwomen:theEuropeanVertebralOsteoporosisStudy.JBoneMinerRes.1996;11:1010-18.

2. Al-SariU,TobiasJ,ClarkE.Healthrelatedqualityoflifeinolderpeoplewithosteoporoticvertebralfractures:asystematicreviewandmeta-analysis.OsteoporosisInt.2016;27(10),2891-909.

3. CooperC,AtkinsonEJ,O’Fallen WM,MeltonLJ3rd.Incidenceofclinicallydiagnosedvertebralfractures:apopulationbased studyinRochester,Minnesota.JBoneMinerRes.1992;7:221-7.

4. MitchellRM,JewellP,Javaid MK,McKeanD,Ostlere SJ.Reportingofvertebralfragilityfractures:canradiologistshelpreducethenumberofhipfractures?ArcOsteoporosis.2017;12(1):71.

5. FreemantleN,CooperC,Diez-PerezA,Gitlin M,RadcliffeH,ShepherdS,etal.Resultsofindirectandmixedtreatmentcomparisonoffractureefficacyforosteoporosistreatments:ameta-analysis.OsteoporosisInt.2013;24(1):209-17.

6. Genant HK,WuCY,vanKuijik C,Nevitt MC.Vertebralfractureassessmentusingasemi-quantitativetechniqueJBMR.1993;8(9):1137-48.

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