Paul McAllister BS, Presenter: Nothing to Disclose

Timothy J. Mosher MD, Abstract Co-Author: Research Consultant, Medical Metrics, Inc Research Consultant, eImage, Inc Research Consultant, Johnson & Johnson Stockholder, Johnson & Johnson

To determine if there is a difference in outcomes for patients with suspected fragility fractures at the femoral neck evaluated using CT in comparison to those evaluated with MRI.

This study was an observational retrospective cohort design. Imaging studies ordered through the emergency department at Milton S. Hershey Medical Center were searched to identify participants. Due to higher prevalence of radiographic occult osteoporotic fractures of the hip, the study was limited to females over the age of 65 who had experienced a fall and were suspected of having a fracture. Patients were included if initial radiographic evaluation of the pelvis or hip was negative for fracture and followed by either a non-contrast CT or MRI of the hip or pelvis. Records were grouped based on whether evaluation for occult fracture was made with CT or MRI. Their electronic medical records were searched for hospitalizations in the year following their index evaluation in the emergency department. Our primary analysis was to compare outcomes thought to be directly related to delayed diagnosis or treatment of suspected fragility fractures.  These outcomes include death, secondary displacement, avascular necrosis, rapid progression of osteoarthritis, delayed diagnosis, and malunion. These were determined based on a literature search conducted prior to the collection of data.    

A database search from the dates of 1/1/05 to 12/31/12 yielded 926 records.  After review, 119 of these records met the inclusion criteria; 21 were evaluated with MRI and 98 with CT.  Statistical analysis showed no significant difference in clinical outcomes during the year following initial evaluation. 8.3% of patients evaluated with MRI experienced adverse outcomes directly related to hip fracture within one year in comparison to 10.6% of patients evaluated with CT (p=1.0).  The most common of these adverse events in both groups was death within the following year.

In contrast to current guidelines that recommend MRI, our results indicate there is no significant difference in clinical outcomes between elderly female patients evaluated with CT or MRI for suspected fragility fractures of the hip following fall.

Appropriateness criteria recommending MRI for suspected occult fragility fractures are based on studies of diagnostic accuracy; however, our results suggest no difference in patient centered outcome.

McAllister, P, Mosher, T, Comparison of Outcomes for Patients Evaluated with Magnetic Resonance Imaging vs CT for Suspected Occult Femoral Neck Fractures.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14005723.html