Does Additional Review of Initial Radiographs by Musculoskeletal Specialists Limit Additional Advanced Imaging in Suspected Hip Fractures?

Abstract

AbstractPatients with suspected fractures of the hip usually require significant time and resources for care, sometimes including advanced imaging. Optimizing care may improve patient outcomes and reduce the financial burden of hip fractures. Few studies have investigated approaches to reduce the utilization of additional imaging to diagnose hip fractures. The objective of this study was to determine if the utilization of computed tomography and magnetic resonance imaging can be reduced for suspected hip fracture patients via additional review of initial hip radiographs by musculoskeletal specialists. This may aid imaging referral guidelines for patients with a clinical suspicion of a hip fracture and reduce the amount of costly additional imaging. A retrospective multicenter study was conducted of hip fracture patients from five hospitals in an academic health system from 2015 to 2018. The study included initial radiographs of 108 patients, all of which were considered inconclusive at the time of service by radiologist reports and subsequently diagnosed with a hip fracture after receiving additional imaging. Four musculoskeletal specialists were asked to evaluate if the radiographs were positive for hip fracture, negative for hip fracture, or required additional imaging. A positive hip fracture was correctly identified by musculoskeletal specialists from the initial radiograph in 37 to 50% of cases. There was no statistically significant difference between reviewers of different levels of training in identifying hip fractures (p = 0.19) or ordering additional imaging (p = 0.235). There was a moderately positive interclass correlation across reviewers who correctly identified a hip fracture (interclass correlation coefficients [ICC] = 0.59, 95% confidence interval [CI]: 0.45–0.70), as well as reviewers who requested additional imaging (ICC = 0.45, 95% CI: 0.25–0.60). Review of initial radiographs by musculoskeletal specialists could reduce the utilization of additional advanced imaging by up to 50% in patients with a suspected hip fracture. This is a level III evidence study.