Incidental vertebral fractures on chest radiographs: Recognition, documentation, and treatment

Charles A. Morris, John A. Carrino, Philipp Lang, Daniel H. Solomon

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)352-356
Number of pages5
JournalJournal of General Internal Medicine
Volume21
Issue number4
DOIs
StatePublished - Apr 2006
Externally publishedYes

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Documentation
Osteoporosis
Thorax
Odds Ratio
Confidence Intervals
Therapeutics
Inpatients
Outpatients
Hospital Records
Tobacco Use
Glucocorticoids
Hospitalization

Keywords

  • Diagnosis
  • Health service research
  • Hospital medicine
  • Osteoporosis
  • Women's health

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Incidental vertebral fractures on chest radiographs : Recognition, documentation, and treatment. / Morris, Charles A.; Carrino, John A.; Lang, Philipp; Solomon, Daniel H.

In: Journal of General Internal Medicine, Vol. 21, No. 4, 04.2006, p. 352-356.

Research output: Contribution to journalArticle

Morris, Charles A. ; Carrino, John A. ; Lang, Philipp ; Solomon, Daniel H. / Incidental vertebral fractures on chest radiographs : Recognition, documentation, and treatment. In: Journal of General Internal Medicine. 2006 ; Vol. 21, No. 4. pp. 352-356.
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abstract = "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.",
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