Pelvic and sacral insufficiency fractures are common, with high morbidity and mortality1 and prolonged hospital stays. Diagnosis using X-ray can be difficult2.
Aim: to assess how fractures are identified and whether delayed fracture diagnosis impacts length of stay and complications. A secondary aim was to audit discharge prescription of osteoporosis medications.
We audited admissions for pelvic and sacral fractures to the Geriatrics and General Medicine departments at the Canberra Hospital between January 2014 and December 2015. Diagnostic imaging modality, time to diagnosis, length of acute stay (LOS); discharge destination, complications and osteoporosis medications on discharge were recorded.
54 patients were identified with mean age 76.3+9.5 years and 88.9% were female. Fractures were diagnosed by X-ray in 59.2% cases. Where initial X-ray was negative, pelvic or sacral fracture was identified using bone (18.5%), CT (16.7%) and MRI (5.6%) scans. Mean day of diagnosis was 2.5+3.4. There was no significant difference in mean LOS (Table) and complications and mortality were low (Table). The audit of prescribing showed 14 (25.9%) patients were discharged on a bone strengthener and 48.1% on cholecalciferol (+ calcium).
|
|
Early diagnosis (< 48 hr) N = 13 |
Late diagnosis (> 48hr) N = 41 |
|
Length of stay (mean + SD) |
12.5 +6.2 |
11.1 + 3.9 P = 0.83 |
|
Complications: |
|
|
|
Pneumonia |
4 |
0 |
|
Delirium |
2 |
3 |
|
Mortality |
1 |
0 |
|
Destination (%) |
|
|
|
Home |
23.1 |
24.4 |
|
Nursing home |
15.4 |
4.9 |
|
Inpatient rehab |
7.7 |
19.5 |
|
Outpatient rehab |
15.4 |
17.1 |
|
Private hospital |
38.5 |
34.1 |
X-ray detected only 2/3 of sacral and pelvic fractures. Further imaging must thus be obtained in the setting of persistent pain or immobility. Delayed diagnosis did not alter the key outcomes. Inpatient treatment of osteoporosis is suboptimal.