243 A missed opportunity for intervention: vertebral fracture reporting

Abstract

Abstract Background Vertebral Fractures (VFs) are the most common fragility fracture—with an incidence of 1 in 5 women over 70. A Vertebral Fragility Fracture (VFF) is a powerful predictor of another VF and of future hip fractures. Yet nearly 70% of VFs do not come to medical attention. Opportunities to identify a VFF and institute secondary prevention arises when a patient is referred for imaging for any clinical reason. However, VFFs are commonly unrecognised radiologically or reported ambiguously. The aim of this audit was to retrospectively evaluate VFF reporting terminology and recommendations as per published guidelines. Methods All radiographic reports from 2021–2023 in an Irish hospital were screened for osteoporotic and VFF key-terms in patients >65 years via the PACs platform. Data was analysed for 1) comments on vertebral integrity; 2) usage of the term ‘vertebral fracture’; 3) inclusion of actionable recommendations. Results A resultant total of 250 reports were reviewed, 223/250 from plain films. Fracture was reported 50.8% (n = 127) of the time. Ambiguous terminology like ‘compression’; ‘sagging’; ‘height loss’ ‘collapse’; ‘wedging’ was used in 49.2% (n = 123). Even where vertebral height loss was reported as 20% or greater, the term ‘fracture’ was not used in 59% (29/49). No report made recommendations for further investigation. Conclusion This audit highlights that even when osteoporotic challenges to vertebral integrity are recognised, they are not reported in a standardised way that reflects the ‘red flag’ significance of a VFF. The heterogeneous and ambiguous reporting fails to alert other clinicians to their significance—resulting in a missed opportunity to intervene. A reporting template and addition of actionable recommendations is for review at the internal monthly radiology quality forum.