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European Radiology
Published in: European Radiology 9/2020

01-09-2020 | Computed Tomography | Musculoskeletal

Radiology reporting of osteoporotic vertebral fragility fractures on computed tomography studies: results of a UK national audit

Authors: David C. Howlett, Karl J. Drinkwater, Nadia Mahmood, Jozsef Illes, Jill Griffin, Kassim Javaid

Published in: European Radiology | Issue 9/2020

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Abstract

Objectives

To evaluate organisational reporting infrastructure and patient-related reporting data in the diagnosis of vertebral fragility fractures (VFFs) as demonstrated on computed tomography (CT).

Methods

Organisational and patient-specific questionnaires were developed by consensus between The Royal College of Radiologists, the Royal College of Physicians, and the Royal Osteoporosis Society. The patient-specific component of the audit involved analysis of CT reporting data acquired from 50 consecutive non-traumatic studies including the thoracolumbar spine. Ethical approval for this type of study is not required in the UK. All UK radiology departments with an audit lead (auditor) registered with The Royal College of Radiologists (RCR) were invited to participate in this retrospective audit.

Results

In total, 127 out of 202 departments (63%) supplied data to the study, with inclusion of 6357 patients. Overall, 1362/6357 patients (21.4%) had a fracture present on auditor review of the CT imaging. There was a lack of compliance with all audit standards: 79% of reports commented on the vertebrae (target 100%), fracture severity was mentioned in 26.2% (target 100%), the recommended terminology ‘vertebral fracture’ was used in 60.1% (target 100%), and appropriate onward referral was recommended in 2.6% (target 100%).

Conclusions

The findings from this study should be used to provide impetus to improve the diagnosis and care for patients with osteoporotic VFFs. Solutions are multifactorial, but radiologist and local osteoporosis/fracture liaison service engagement is fundamental, combined with necessary development of electronic report notification systems and expansion of supporting fracture services.

Key Points

• Early detection and diagnosis of vertebral fragility fractures (VFFs) significantly reduce patient morbidity and mortality. This study describes the results of a retrospective UK-wide audit evaluating current radiology reporting practice in the opportunistic diagnosis of VFFs as demonstrated on computed tomography (CT) studies including the spine.
• Key audit standards included comment made on bone integrity in primary report (target 100%), comment made on severity of fractures (90%), report used recommended terminology ‘fracture’ (100%), and report made appropriate recommendations for referral/further assessment (100%). The audit results demonstrated a lack of compliance with all audit standards; lack of compliance was most marked in the use of recommended terminology (achieved 60.3%), in relation to comment on fracture severity (achieved 26.2%) and for recommendation for referral/further assessment (achieved 2.6%).
• Solutions are challenging and multifactorial but the opportunity exists for all radiologists to examine their practice and directly improve patient care.
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Metadata
Title
Radiology reporting of osteoporotic vertebral fragility fractures on computed tomography studies: results of a UK national audit
Authors
David C. Howlett
Karl J. Drinkwater
Nadia Mahmood
Jozsef Illes
Jill Griffin
Kassim Javaid
Publication date
01-09-2020
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 9/2020
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-020-06845-2

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