Negative predictive value of CT for occult fractures of the hip and pelvis with imaging follow-up
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ORIGINAL ARTICLE
Negative predictive value of CT for occult fractures of the hip and pelvis with imaging follow-up Andrew H. Haims 1
&
Annie Wang 1 & Brad J. Yoo 2 & Jack Porrino 1
Received: 10 June 2020 / Accepted: 30 July 2020 # American Society of Emergency Radiology 2020
Abstract Purpose To determine the negative predictive value of multidetector CT for radiographically occult fracture of the hip or pelvis in an elderly population presenting to the emergency department. Methods Two hundred thirty-seven elderly patients with suspected fracture were identified over a 5-year period with negative radiographs acquired in the emergency department followed by an index CT of the hip/pelvis within 24 h. There were 81 cases with a negative index CT, as determined by 2 musculoskeletal radiologists, and with some form of imaging follow-up (MRI, CT, or x-ray) performed within 18 months of the index CT. Follow-up imaging was reviewed by 2 musculoskeletal radiologists for the presence of fracture to determine the performance of the index CT. The electronic medical record was used to exclude the possibility of intervening trauma between the time of the index CT and follow-up imaging. Results There were 39 cases with follow-up imaging performed within 6 weeks of the negative index CT, and 42 with follow-up imaging within 6 weeks to 18 months of the negative index CT. Eight of 81 patients demonstrated a fracture on follow-up imaging, with 3 of 8 involving the femoral neck or intertrochanteric femur. The negative predictive value of the index CT for the detection of a radiographically occult hip or pelvic fracture was 90.1%. If considering only surgically relevant fractures (femoral neck and intertrochanteric fractures), the negative predictive value improved to 96.3%. Conclusion Computed tomography for occult hip fractures has a high negative predictive value but there are cases not detected with surgical implications. Keywords Computerized tomography . Occult hip fracture
Introduction Fractures of the hip in the elderly are a serious problem facing our healthcare system with a 1-month mortality rate of
* Andrew H. Haims [email protected] Annie Wang [email protected] Brad J. Yoo [email protected] Jack Porrino [email protected] 1
Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA
2
Orthopedics and Rehabilitation, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA
approximately 10% [1, 2]. This number doubles if surgery is delayed to greater than 2 days [3–5] illustrating the importance of early, accurate diagnosis. The majority of hip fractures are diagnosed with plain radiography but occult hip fracture rates range from 2 to 10% [6]. Further imaging evaluation of patients with an initial negative radiography and a concern for occult fracture of the hip has been debated, with most literature supporting the use of magnetic resonance imaging (MRI) over computed tomography (CT). However, the American College of Radiology (A
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