Identification of minimal trauma fractures – Utility of an automated search for fragility fractures within an Osteoporosis Refracture Prevention Service — ASN Events
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Identification of minimal trauma fractures – Utility of an automated search for fragility fractures within an Osteoporosis Refracture Prevention Service (#184)

Lillias Nairn 1 , Christine Harvey 2 , Seven Guney 3 , Robyn Speerin 4 , Belinda Jones 1 , Christian Girgis 1 5 , Lyn March 1 5 , Roderick Clifton-Bligh 1 5
  1. Royal North Shore Hospital, St Leonards, NSW, Australia
  2. Ministry of Health, Sydney
  3. Kolling Institute, North Shore Local Health District, Sydney
  4. Musculoskeletal Network, NSW Agency for Clinical Innovation, Sydney
  5. The University of Sydney, Sydney

Background

Osteoporosis is an underdiagnosed condition and screening rates are generally low in individuals with a minimal trauma fracture (MTF). This is despite strong evidence that refracture risk more than doubles after the initial MTF. Osteoporotic Re-fracture Prevention (ORP) Services significantly reduce refracture rate and are cost-effective. However, methods to identify MTF cases are not standardised across institutions and few comparisons have been made between fracture screening tools.

 

Method

The Royal North Shore Hospital ORP Service, developed as part of a Northern Sydney Local Health District-wide service, transitioned from a manual search of MTF cases presenting to RNSH Emergency Department, to an automated electronic screening (AES) tool employing SNOMED-CT and ICD-10 codes (for diagnosis, procedures, and Radiology report keyword search). The AES tool, which examines multiple hospital care settings including inpatient wards, emergency and outpatient services, was developed to improve efficiency and accuracy of case identification. Eligible cases included patients >50 years presenting to RNSH with a MTF.

This study compares rates of fracture identification using the AES tool (over 4-months) versus the older manual screening method (over 10 months).

 Results

The AES tool and subsequent case triage proved time-effective.

The AES tool identified 169 MTF cases per month versus 94 in the manual screening tool (1.8-fold higher). However the number of true MTF was over-estimated by the AES tool with an increase in false positives from 10.3% in the manual tool to 17.7% in the AES tool (1.7-fold higher). A major advantage of the automated search is identification of incidental vertebral compression fractures which have not presented to ED.

 Conclusion

An AES tool efficiently identifies MTF in an ORP service and substantially increases rates of fracture identification. However a similar magnitude increase in false-positive rate was detected, underlying the importance of subsequent case triage and fracture evaluation.

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