Department of Medicine, Kaiser Permanente San Francisco Medical Center, San Francisco, CA, USA.
Osteoporos Int. 2012 Feb;23(2):743-50. doi: 10.1007/s00198-011-1622-1. Epub 2011 May 12.
Hospital diagnosis codes are useful for assessing hip fracture rates in large populations. However, these codes do not reliably differentiate hip fractures that occur in the subtrochanteric region. Identification of subtrochanteric fractures requires review of radiographic images to distinguish these fractures from the more commonly occurring trochanteric fractures.
This study examines the accuracy of coded hospital diagnoses for hip fracture compared to fracture site verification based on operative and radiologic data. The variability in subtrochanteric fracture assignment was also examined using different anatomic criteria.
This retrospective study includes female members of Kaiser Permanente Northern California age 60 years and older with nontraumatic hip fracture during 2007-2008. Anatomic site was verified by operative and radiologic records, including radiographic image review for fractures occurring in the subtrochanteric region. Two different criteria were compared for subtrochanteric fracture.
We identified 2,824 women with incident hip fracture during the 2-year period. The average age was 82.9 ± 8.2 years and 15% were non-White. International Classification of Diseases, Ninth Revision (ICD-9) coding was accurate for femoral neck and trochanteric fractures (>90% confirmed by operative/radiologic reports), compared to only 26% for subtrochanteric fractures using the Orthopedic Trauma Association (OTA) criteria for subtrochanteric fracture. Using OTA classification, 1.3% of hip fractures were assigned as subtrochanteric compared to 4.2% when the criteria were broadened to include the lesser trochanter. Both femoral neck and pertrochanteric fracture rates increased exponentially with age, while age-related rates in subtrochanteric fracture differed by diagnostic classification method; the broader criteria including the lesser trochanter produced age-related trends that mirrored femoral neck and pertrochanteric fractures.
Unlike femoral neck and pertrochanteric fractures, epidemiologic studies of subtrochanteric fractures cannot rely on ICD-9 codes alone. Review of radiologic images using OTA criteria is required for identification of subtrochanteric fractures occurring below the lesser trochanter.
医院诊断代码可用于评估大人群中的髋部骨折发生率。然而，这些代码并不能可靠地区分发生在转子下区域的髋部骨折。要识别转子下骨折，需要审查放射图像以将这些骨折与更常见的转子间骨折区分开来。
本研究通过手术和放射数据，比较基于编码的医院诊断与骨折部位验证，评估髋部骨折的编码诊断的准确性。还使用不同的解剖标准检查转子下骨折分配的变异性。
本回顾性研究包括 2007-2008 年期间在 Kaiser Permanente Northern California 年满 60 岁的女性非外伤性髋部骨折患者。解剖部位通过手术和放射记录进行验证，包括对转子下区域发生的骨折进行放射图像审查。比较了两种不同的标准用于转子下骨折。
在 2 年期间，我们共确定了 2824 例髋部骨折女性患者。平均年龄为 82.9±8.2 岁，15%是非白人。国际疾病分类，第九修订版（ICD-9）编码对于股骨颈和转子间骨折是准确的（>90%通过手术/放射报告证实），而使用骨科创伤协会（OTA）的转子下骨折标准，只有 26%的转子下骨折是准确的。使用 OTA 分类，1.3%的髋部骨折被归类为转子下骨折，而当标准放宽到包括小转子时，4.2%的髋部骨折被归类为转子下骨折。股骨颈和股骨粗隆间骨折的发生率随年龄呈指数增长，而转子下骨折的年龄相关发生率因诊断分类方法而异；包括小转子的更广泛标准产生的年龄相关趋势与股骨颈和股骨粗隆间骨折相似。
与股骨颈和股骨粗隆间骨折不同，转子下骨折的流行病学研究不能仅依赖 ICD-9 代码。需要使用 OTA 标准审查放射图像，以识别发生在小转子下方的转子下骨折。
