Preventing a second fracture is challenging when patients present to numerous clinical services via different referral pathways. Management usually requires radiographic confirmation of fracture. The radiology report may be a resource that can be mined for secondary fracture prevention. Rippledown is a knowledge based software (KBS) application that can be taught to identify fractures in radiology reports.

Method

426 hip and pelvis radiology reports were entered into KBS. KBS was instructed to screen for fractures identified in the report. We compared this to a manual review of the clinical note included with the request and the radiology report to assign fractures identified or excluded.

Results

147 (34.5%) cases had clinical notes provided with the request. 32 (7.5%) included fracture as a definite diagnosis (10) or a possibility (22). The 10 with the highest clinical certainty had radiology reports confirming 9 with fracture and 1 without fracture at the site examined (femur) yet a previous fracture at an adjacent site (pelvis). Where fracture was a diagnostic possibility 8 had a definite fracture and 14 excluded fracture at the site examined but 2 where a previous or adjacent fracture had been identified. 394 reports did not have clinical notes or notes that did not include the word fracture. KBS identified fracture in 221 reports (56%). 166 were over the age of 70.

Conclusion

KBS can screen radiology reports for the presence or absence of fracture. Coupled with data included in the report (age and gender) a stratified list of patients at possible risk of a second osteoporotic fracture can be generated. KBS may be a useful tool for fracture liaison services that currently rely on case finding or direct patient referral.