AJR: Radiography offers poor findings for hip, pelvis pain in ED
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In a study published in the April issue of the American Journal of Roentgenology, lead author Matthew W. Kirby, MD, and colleagues said that as well as evaluating radiographic detection of hip and pelvic fractures, another purpose of the research was to evaluate the benefit, if any, of MRI in the diagnosis of pelvic and hip fractures in this specific patient population.
Noting the study’s importance, the authors wrote, “the high morbidity and mortality associated with hip and pelvic fractures after trauma in the elderly population have been well studied, as has the long-term outcome after such fractures. Many of these patients arrive in the emergency department with a history of fall and pain localized to the hip. Mortality increases even further among extremely elderly persons, and management is often complicated by comorbid conditions.”
The researchers utilized the medical centers’ MRI database for diagnosis and imaging procedure codes for lower extremity MRI in the ED from July 2005 through June 2008. Based on inclusion criteria consisting of undergoing radiography of the hip, pelvis, or femur in the emergency department followed by diagnostic MRI of the hip or pelvis within one calendar day, 92 patients (77 women, 15 men with an average age of 70.8 years) and 97 exams were selected for the study.
All radiographs of the pelvis or hip obtained within one calendar day before MRI were retrospectively reviewed first. With the radiographs available for review, MRI were subsequently assessed for fractures, bursitis, tendinopathy, muscle injury and other potential causes of pain by two musculoskeletal radiologists who were blinded to the results of each radiographic and MRI exams, said the researchers. In addition, all radiographs and MR images were reviewed in regard to patient age and sex, they wrote.
Noting the elderly female bias, the authors said that 14 percent of the patients with normal radiographic findings were found to have 23 fractures via MRI (six hip and 17 pelvic fractures). MRI showed no fracture after radiographic findings had suggested the presence of a fracture in 12 percent of the population). MRI depicted 12 additional pelvic fractures not identified on radiographs for 15 patients who had abnormal findings on their radiography exam.
In 73 percent of the patients "without MRI evidence of a fracture, the MRI findings suggested the presence of a potential pain generator, including muscle edema and tears, trochanteric bursitis, and hamstring tendinopathy,” the researchers added.
Kirby and colleagues said that fractures around the hip have been reported to account for 50 percent of total hospitalization days for all patients with fractures, and distinction is important in terms of healthcare utilization.
“There has been much research into the challenge of diagnosing hip and pelvic fractures with radiography and into the use of MRI when radiographic findings are normal or equivocal,” they said. “Accurate diagnosis of hip and pelvic fractures in the emergency department can speed patients to surgical management, if needed, and reduce the rate of hospital admissions among patients who do not have fractures.”