The authors have no conflicts of interest to report.
Incidental Vertebral Fractures on Chest Radiographs
Recognition, Documentation, and Treatment
Article first published online: 3 MAY 2006
Journal of General Internal Medicine
Volume 21, Issue 4, pages 352–356, April 2006
How to Cite
Morris, C. A., Carrino, J. A., Lang, P. and Solomon, D. H. (2006), Incidental Vertebral Fractures on Chest Radiographs. Journal of General Internal Medicine, 21: 352–356. doi: 10.1111/j.1525-1497.2006.00395.x
- Issue published online: 3 MAY 2006
- Article first published online: 3 MAY 2006
- Manuscript received November 17, 2004Initial editorial decision February 14, 2005Final acceptance December 14, 2005
- health service research;
- women's health;
- hospital medicine
BACKGROUND: Recognition of incidental vertebral fractures may be an important opportunity for identifying and treating osteoporosis.
OBJECTIVE: To assess osteoporosis documentation rates in patients with vertebral fractures, and to define patient and hospitalization characteristics associated with osteoporosis management.
DESIGN: Hospital and outpatient records were abstracted for patients with vertebral fractures on inpatient radiograph reports. The primary outcome of interest was discharge summary fracture documentation. Covariates associated with fracture documentation and treatment were examined with multivariate regression models. Secondary outcomes included osteoporosis documentation and management 6 months following discharge.
PATIENTS: Women ≥50 years hospitalized at an academic medical center.
RESULTS: Among 10,291 women with chest radiographs, 142 (1.4%) had vertebral fractures reported. Among patients with a reported fracture, 58 (41%) had their fracture noted in the findings section but not in the final impression. Only 23 (16%) discharge summaries documented a vertebral fracture. Factors associated with documentation of the fracture in the discharge summary included notation of the fracture in the impression section (odds ratio [OR] 3.7, 95% confidence interval [CI] 1.0 to 13.1), tobacco use (OR 3.7; 95% CI 1.1 to 12.2), discharge from a medical service (OR 7.6; 95% CI 0.9 to 66.2) and glucocorticoid use (OR 3.7; 95% CI 0.8 to 17.0). Only 36% of patients were using any osteoporosis medications at discharge. Fracture notation in the impression section was associated with fracture documentation in subsequent outpatient notes (OR 3.6, 95% CI 0.9 to 13.8). Discharge summary fracture documentation was associated with an increased likelihood of starting an osteoporosis medication by 6 months (OR 2.8; 95% CI 0.8 to 9.2).
CONCLUSIONS: Incidental vertebral fractures from inpatient chest radiographs may represent a missed opportunity for osteoporosis management.