Rapid access imaging for occult fractured neck of femur

详细信息    查看全文

• 作者：S. Tiwari ; W. S. De Rover ; S. Dawson ; C. Moran ; O. Sahota
• 关键词：Elderly ; Hip fracture ; Magnetic resonance imaging ; Occult fracture
• 刊名：Osteoporosis International
• 出版年：2015
• 出版时间：January 2015
• 年：2015
• 卷：26
• 期：1
• 页码：407-410
• 全文大小：112 KB
• 参考文献：1. The management of hip fracture in adults, NICE Guidance, June 2011. HYPERLINK
  2. British Orthopaedic Association (2007). The care of patients with fragility fractures. (Guideline Ref ID: BOA2007). HYPERLINK
  3. Injury. 2007 Oct; 38(10):1204-. Epub 2007 Sep 18. Is magnetic resonance imaging (MRI) necessary to exclude occult hip fracture? Hossain M, Barwick C, Sinha AK, Andrew JG. Department of Orthopaedics and Trauma, Ysbyty Gwynedd, Bangor, UK
  4. Arch Orthop Trauma Surg. 2010 Jul;130(7):915-0. doi: 10.1007/s00402-010-1105-4. Epub 2010 May 1. Initially missed occult fractures of the proximal femur in elderly patients: implications for need of operation and their morbidity. Kim KC, Ha YC, Kim TY, Choi JA, Koo KH. Department of Orthopaedic Surgery, Pohang St. Mary′s Hospital, Daejam-Dong, Nam-gu, South Korea,. HYPERLINK
  5. Gill SK, Smith J, Fox R, Chesser TJS (2013) Investigation of occult hip fractures: the use of CT and MRI. Scientific World Journal 2013:830319. doi:10.1155/2013/830319 CrossRef
  6. Verbeeten KM, Hermann KL, Hasselqvist M, Lausten GS, Joergensen P, Jensen CM, Thomsen HS (2005) The advantages of MRI in the detection of occult hip fractures, vol 1. Department of Diagnostic Radiology, Copenhagen University Hospital at Herlev, Herlev Ringvej 75, DK-2730 Herlev, Denmark, pp 165-
  7. Prevalence and patterns of occult hip fractures and mimics revealed by MRI, Mayumi Oka and Johnny U.V. Monu, American Journal of Roentgenology 2004:182: 283-88. 10.2214/ajr.182.2.1820283, Department of Radiology, University of Radiology, University of Rochester School of Medicine and Dentistry, University of Rochester Medical Center. HYPERLINK
  8. Acta Orthopaedica 2005; 76 (4): 524-30 MRI diagnosis of occult hip fractures Frede Frihagen1, Lars Nordsletten1, Rana Tariq2 and Jan Erik Madsen Orthopedic Center, 2Department of Radiology, Musculoskeletal Division, Ullev?l University Hospital, NO-0407 Oslo, Norway. HYPERLINK
  9. Radiology. 1995 Oct; 197 (1):263- MR imaging in evaluation of suspected hip fracture: frequency of unsuspected bone and soft-tissue injury. Bogost GA, Lizerbram EK, Crues JV 3rd, Cedars Sinai Imaging, Cedars Sinai Medical Center, Los Angeles, Calif., USA. HYPERLINK
  10. David A, Purins JL, Smith DK (1996) MR imaging of occult traumatic fractures and muscular injuries of the hip and pelvis in elderly patients. American Journal of Roentgenology 166:1075-078. doi:10.2214/ajr.166.5.8615246 CrossRef
  11. Review article: magnetic resonance imaging and computed tomography in the diagnosis of occult proximal femur fracturesHamid A Chatha,1 Sana Ullah,2 Zulfiqar Z Cheema31 Institute of Orthopaedics and Musculoskeletal Science, University College London, United Kingdom 2 Department of Surgery, Castle Hill Hospital, Cottingham, United Kingdom 3 Department of Orthopaedics, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia, Journal of Orthopaedic Surgery 2011;19 (1):99-03 HYPERLINK
  
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Orthopedics
  Gynecology
  Endocrinology
  Rheumatology
  
• 出版者：Springer London
• ISSN：1433-2965

文摘

Summary We completed a full audit cycle to assess waiting times for inpatients with suspected occult femoral neck fracture to get MRI scan, identify the causes of delay and implement the changes to reduce the waiting times. We have proved that inpatient MRI waiting times can significantly be reduced by a targeted approach. Introduction The timely management of hip fractures is now underpinned by NICE Guidance, June 2011. This includes a statement that magnetic resonance imaging (MRI) should be offered if occult femoral neck fracture is suspected and that MRI should be made available within 24?hours. We completed a full audit cycle: (1) analyse the time taken for inpatient MRI to be performed for suspected occult femoral neck fractures, (2) identify correctable reasons for delay, (3) develop and implement changes and (4) re-audit. Methods Data was collected from the computerised radiology information system on consecutive patients between 01/04/2010 and 31/03/2012. This data was presented at a number of directorate audit meetings. Following the development and implementation of targeted improvements, a prospective re-audit was carried out between 01/08/2012 and 31/07/2013. Results After the initial audit, various reasons of delay were identified. The correctable causes for delay were (1) duty radiologist not directly contacted by clinician to request urgent scan, (2) slow vetting and protocoling of electronic requests, (3) resistance to weekend scanning and (4) delay in completing MRI safety questionnaire. After implementing strategies to address these remediable causes of delay, the re-audit demonstrated a 16?% improvement in patients scanned within 24?h. The mean waiting time to get an MRI was 2,025.4?min (SD 2,406.4) for the baseline audit and 1,374?min (SD 1,635.7) for the re-audit. Mean difference is 651.4?min (95?% CI 85.21, 1,217.5; p--.0243). Conclusion MRI is a useful and sensitive tool to investigate occult femoral neck fracture. Inpatient MRI waiting times can significantly be reduced by a targeted approach which embodies improved team working.