Advertisement

Dedicated MRI in the emergency department to expedite diagnostic management of hip fracture

  • Holly Gil
  • Ashley A. Tuttle
  • Laura A. Dean
  • David A. Johnson
  • David Portelli
  • Janette Baird
  • Neha P. RaukarEmail author
Original Article
  • 55 Downloads

Abstract

Purpose

To determine the effect on time to diagnosis of making MRI imaging for hip fractures available directly in the emergency department (ED).

Methods

We conducted a retrospective observational study of patients with MRI imaging of the hip for suspected occult fracture, comparing time to diagnosis and time to disposition of populations imaged in the year preceding and the year following installation of an MRI scanner in the ED.

Results

Time to diagnosis of hip fractures was 709 min before installation of a dedicated ED MRI scanner and 280 min after, a 60% reduction. Including the MRI in the diagnostic workup did not increase ED throughput time, and we were able to save 48% of the patients who had an ED-based MRI from an admission to the hospital.

Conclusion

Implementation of an MRI scanner for dedicated emergency department use enables faster hip fracture diagnosis and surgical consultation, or definitive disposition without increasing ED throughput time.

Keywords

MRI Emergency Hip fracture Triage 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Hamlet WP, Lieberman JR, Freedman EL, Dorey FJ, Fletcher A, Johnson EE (1997) Influence of health status and the timing of surgery on mortality in hip fracture patients. Am J Orthop (Belle Mead NJ) 26(9):621–627Google Scholar
  2. 2.
    Villar RN, Allen SM, Barnes SJ (1986) Hip fractures in healthy patients: operative delay versus prognosis. Br Med J (Clin Res Ed) 293(6556):1203–1204CrossRefGoogle Scholar
  3. 3.
    Bredahl C, Nyholm B, Hindsholm KB, Mortensen JS, Olesen AS (1992) Mortality after hip fracture: results of operation within 12 h of admission. Injury 23(2):83–86CrossRefGoogle Scholar
  4. 4.
    Downey C, Kelly M, Quinlan JF (2019) Changing trends in the mortality rate of 1-year post hip fracture - a systemic review. World J Orthop 10(3):166–175CrossRefGoogle Scholar
  5. 5.
    Dominguez S, Liu P, Roberts C, Mandell M, Richman PB (2005) Prevalence of traumatic hip and pelvic fractures in patients with suspected hip fracture and negative initial standard radiographs - a study of ED patients. Acad Emerg Med 12(4):366–369PubMedGoogle Scholar
  6. 6.
    Hakkarinen DK, Banh KV, Hendey GW (2012) Magnetic resonance imaging identifies occult hip fractures missed by 64-slice computed tomography. J Emerg Med 43(2):303–307CrossRefGoogle Scholar
  7. 7.
    Collin D, Geijer M, Gothlin J (2016) Computer tomography compared to magnetic resonance imaging in occult or suspect hip fracture. A retrospective study in 44 patients. Eur Radiol 26:3932–3938CrossRefGoogle Scholar
  8. 8.
    Ward RJ, Weissman BN, Kransdorf MJ, Adler R, Appel M, Bancroft LW, Bernard SA, Bruno MA, Fries IB, Morrison WB, Mosher TJ, Roberts CC, Scharf SC, Tuite MJ, Zoga AC (2014) ACR appropriateness criteria acute hip pain-suspected fracture. J Am Coll Radiol 11(2):114–120CrossRefGoogle Scholar
  9. 9.
    Carretta E, Bochicchio V, Rucci P, Fabbri G, Laus M, Fantini MP (2011) Hip fracture: effectiveness of early surgery to prevent 30-day mortality. Int Orthop 35(3):419–424CrossRefGoogle Scholar
  10. 10.
    Ryan DJ, Yoshihara H, Yoneoka D, Egol KA, Zuckerman JD (2015) Delay in hip fracture surgery: an analysis of patient- and hospital-specific risk factors. J Orthop Trauma 29(8):343–348CrossRefGoogle Scholar
  11. 11.
    Bretherton CP, Parker MJ (2015) Early surgery for patients with a fracture of the hip decreases 30-day mortality. Bone Joint J 97-B(1):104–108CrossRefGoogle Scholar
  12. 12.
    Saboo SS, Lin YC, Juan YH, Patel K, Weaver M, Sodickson A, Khurana B (2015) Magnetic resonance imaging for acute hip pain in the emergency department. Emerg Radiol 22(4):409–422CrossRefGoogle Scholar
  13. 13.
    Health Forum (2015) L., an affiliate of the American Hospital Association., 1999 - 2013 AHA Annual Survey, in American Hospital AssociationGoogle Scholar
  14. 14.
    Orosz GM, Magaziner J, Hannan EL, Morrison RS, Koval K, Gilbert M, McLaughlin M, Halm EA, Wang JJ, Litke A, Silberzweig SB, Siu AL (2004) Association of timing of surgery for hip fracture and patient outcomes. JAMA 291(14):1738–1743CrossRefGoogle Scholar
  15. 15.
    Morrison RS et al (2003) The impact of post-operative pain on outcomes following hip fracture. Pain 103(3):303–311CrossRefGoogle Scholar
  16. 16.
    Morrison RS et al (2003) Relationship between pain and opioid analgesics on the development of delirium following hip fracture. J Gerontol A Biol Sci Med Sci 58(1):76–81CrossRefGoogle Scholar
  17. 17.
    Francis J, Kapoor WN (1992) Prognosis after hospital discharge of older medical patients with delirium. J Am Geriatr Soc 40(6):601–606CrossRefGoogle Scholar
  18. 18.
    Baptiste D, Fecher AM, Dolejs SC, Yoder J, Schmidt CM, Couch ME, Ceppa DKP (2017) Gender differences in academic surgery, work-life balance, and satisfaction. J Surg Res 218:99–107CrossRefGoogle Scholar
  19. 19.
    Zuckerman JD et al (1992) Hip fractures in geriatric patients. Results of an interdisciplinary hospital care program. Clin Orthopaedics Related Res 274:213–225Google Scholar

Copyright information

© American Society of Emergency Radiology 2019

Authors and Affiliations

  1. 1.Department of RadiologyBrown UniversityProvidenceUSA
  2. 2.Alpert Medical School of Brown UniversityProvidenceUSA
  3. 3.Department of Emergency MedicineBrown UniversityProvidenceUSA
  4. 4.Department of Emergency MedicineMayo ClinicRochesterUSA

Personalised recommendations