Howlett David C, Drinkwater Karl J, Mahmood Nadia, Illes Jozsef, Griffin Jill, Javaid Kassim
Eastbourne Hospital, Eastbourne, UK.
The Royal College of Radiologists, 63 Lincoln's Inn Fields, London, WC2A 3JW, UK.
Eur Radiol. 2020 Sep;30(9):4713-4723. doi: 10.1007/s00330-020-06845-2. Epub 2020 May 20.
To evaluate organisational reporting infrastructure and patient-related reporting data in the diagnosis of vertebral fragility fractures (VFFs) as demonstrated on computed tomography (CT).
Organisational and patient-specific questionnaires were developed by consensus between The Royal College of Radiologists, the Royal College of Physicians, and the Royal Osteoporosis Society. The patient-specific component of the audit involved analysis of CT reporting data acquired from 50 consecutive non-traumatic studies including the thoracolumbar spine. Ethical approval for this type of study is not required in the UK. All UK radiology departments with an audit lead (auditor) registered with The Royal College of Radiologists (RCR) were invited to participate in this retrospective audit.
In total, 127 out of 202 departments (63%) supplied data to the study, with inclusion of 6357 patients. Overall, 1362/6357 patients (21.4%) had a fracture present on auditor review of the CT imaging. There was a lack of compliance with all audit standards: 79% of reports commented on the vertebrae (target 100%), fracture severity was mentioned in 26.2% (target 100%), the recommended terminology 'vertebral fracture' was used in 60.1% (target 100%), and appropriate onward referral was recommended in 2.6% (target 100%).
The findings from this study should be used to provide impetus to improve the diagnosis and care for patients with osteoporotic VFFs. Solutions are multifactorial, but radiologist and local osteoporosis/fracture liaison service engagement is fundamental, combined with necessary development of electronic report notification systems and expansion of supporting fracture services.
• Early detection and diagnosis of vertebral fragility fractures (VFFs) significantly reduce patient morbidity and mortality. This study describes the results of a retrospective UK-wide audit evaluating current radiology reporting practice in the opportunistic diagnosis of VFFs as demonstrated on computed tomography (CT) studies including the spine. • Key audit standards included comment made on bone integrity in primary report (target 100%), comment made on severity of fractures (90%), report used recommended terminology 'fracture' (100%), and report made appropriate recommendations for referral/further assessment (100%). The audit results demonstrated a lack of compliance with all audit standards; lack of compliance was most marked in the use of recommended terminology (achieved 60.3%), in relation to comment on fracture severity (achieved 26.2%) and for recommendation for referral/further assessment (achieved 2.6%). • Solutions are challenging and multifactorial but the opportunity exists for all radiologists to examine their practice and directly improve patient care.
评估组织报告基础设施以及计算机断层扫描（CT）显示的椎体脆性骨折（VFF）诊断中与患者相关的报告数据。
皇家放射科医师学院、皇家内科医师学院和皇家骨质疏松症协会经协商制定了组织层面和针对患者的调查问卷。审计中针对患者的部分涉及对从50例连续的包括胸腰椎的非创伤性研究中获取的CT报告数据进行分析。在英国，这类研究无需伦理批准。所有在皇家放射科医师学院（RCR）注册有审计负责人（审计员）的英国放射科均受邀参与这项回顾性审计。
202个部门中共有127个（63%）为该研究提供了数据，纳入患者6357例。总体而言，在审计员对CT影像的审查中，1362/6357例患者（21.4%）存在骨折。所有审计标准均未得到遵守：79%的报告对椎体进行了评论（目标为100%），提及骨折严重程度的报告占26.2%（目标为100%），使用推荐术语“椎体骨折”的报告占60.1%（目标为100%），建议进行适当后续转诊的报告占2.6%（目标为100%）。
本研究结果应用于推动改善骨质疏松性VFF患者的诊断和护理。解决方案是多方面的，但放射科医师与当地骨质疏松症/骨折联络服务机构的参与是根本，同时需要开发必要的电子报告通知系统并扩大骨折支持服务。
• 椎体脆性骨折（VFF）的早期检测和诊断可显著降低患者的发病率和死亡率。本研究描述了一项全英国范围的回顾性审计结果，该审计评估了在包括脊柱的计算机断层扫描（CT）研究中对VFF进行机会性诊断时当前的放射学报告实践。• 关键审计标准包括在初次报告中对骨完整性进行评论（目标为100%）、对骨折严重程度进行评论（90%）、报告使用推荐术语“骨折”（100%）以及报告对转诊/进一步评估提出适当建议（100%）。审计结果表明所有审计标准均未得到遵守；在使用推荐术语方面（达到60.3%）、在对骨折严重程度的评论方面（达到26.2%）以及在转诊/进一步评估建议方面（达到2.6%），未遵守情况最为明显。• 解决方案具有挑战性且是多方面的，但所有放射科医师都有机会审视自己的实践并直接改善患者护理。
