Cargando…
Underreporting characteristics of osteoporotic vertebral fracture in back pain clinic patients of a tertiary hospital in China
AIM: Osteoporotic vertebral compressive fractures (VCFs) are known to be commonly missed in X-rays indicated for pulmonary or heart diseases. In this study, we investigated the underreporting status of VCF in back pain clinic patients when the spine was the focus of interest. MATERIALS AND METHODS:...
Autores principales: | , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Chinese Speaking Orthopaedic Society
2019
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7452293/ https://www.ncbi.nlm.nih.gov/pubmed/32913707 http://dx.doi.org/10.1016/j.jot.2019.10.007 |
_version_ | 1783575137298153472 |
---|---|
author | Du, Mei-Mei Che-Nordin, Nazmi Ye, Pei-Pei Qiu, Shi-Wen Yan, Zhi-Han Wang, Yi Xiang J. |
author_facet | Du, Mei-Mei Che-Nordin, Nazmi Ye, Pei-Pei Qiu, Shi-Wen Yan, Zhi-Han Wang, Yi Xiang J. |
author_sort | Du, Mei-Mei |
collection | PubMed |
description | AIM: Osteoporotic vertebral compressive fractures (VCFs) are known to be commonly missed in X-rays indicated for pulmonary or heart diseases. In this study, we investigated the underreporting status of VCF in back pain clinic patients when the spine was the focus of interest. MATERIALS AND METHODS: This is a retrospective analysis of 105 female cases (mean: 72 years, range: 55–93 years) from a tertiary hospital in China (facility A, FA). The patients with back and/or leg pain were referred for a spine X-ray. The images were retrieved and transferred to a central reading facility (facility B, FB), where images were double-read by two readers experienced in evaluating osteoporotic vertebral compressive deformity (VCD)/VCF. A qualitative VCD with <20%, 20–25%, 25–40%, and >40% vertebral body height loss was recorded as minimal, mild, moderate, and severe grades, respectively. A VCD coexisted with endplate/cortex fracture (ECF) was VCF. FB readings were considered as the reference. RESULTS: There were 34 true negative cases where FA and FB had a consensus. In 7 cases with minimal VCD, 3 cases with ECF, and 7 cases with minimal or mild VCFs, the FA readings were false negative. No standalone singular moderate or severe VCD/VCF in a patient was missed in FA's reports. In 25 FA reading positive cases with multiple VCFs, one VCF was missed in 8 cases, more than one VCF was missed in 15 cases, and one additional ECF was missed in 2 cases. In 14 cases, FA and FB had VCF number agreement, with the term ‘vertebral fracture’ was used appropriately in FA reports. In 15 cases, FA and FB had agreement in VCF number; however, the appropriate term ‘vertebral fracture’ was not used in FA reports; instead the terms of ‘compressive change’ or ‘wedging change’ were used. In most VCFs, severity grading was not given in FA. In 13 VCFs where grading was reported, all were marked as ‘mild’, including seven mild VCFs, five moderate VCFs, and even one severe VCF. CONCLUSION: Among the patients with VCD/VCF, the false negative rate among was 23.9% (17/71), but the missed cases were all minimal or mild grades. One or more VCFs were missed in 32.4% (23/71) of the cases with multiple VCFs. Appropriate severity grading was not reported for most cases. THE TRANSLATIONAL POTENTIAL OF THIS ARTICLE: The underreporting rate of osteoporotic vertebral compressive fracture in back pain clinic patients in a typical tertiary hospital setting in China compared favorably with literature reports. However, there is a general lack of awareness of vertebral endplate/cortex fracture sign and vertebral fracture severity grading, while minimal and mild VCD with endplate/cortex fracture may have clinical significance. Moreover, after one VCF is spotted in a patient, it is highly advisable to carefully check the whole spine so that multiple VCFs will not be missed. |
format | Online Article Text |
id | pubmed-7452293 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Chinese Speaking Orthopaedic Society |
record_format | MEDLINE/PubMed |
spelling | pubmed-74522932020-09-09 Underreporting characteristics of osteoporotic vertebral fracture in back pain clinic patients of a tertiary hospital in China Du, Mei-Mei Che-Nordin, Nazmi Ye, Pei-Pei Qiu, Shi-Wen Yan, Zhi-Han Wang, Yi Xiang J. J Orthop Translat Original Article AIM: Osteoporotic vertebral compressive fractures (VCFs) are known to be commonly missed in X-rays indicated for pulmonary or heart diseases. In this study, we investigated the underreporting status of VCF in back pain clinic patients when the spine was the focus of interest. MATERIALS AND METHODS: This is a retrospective analysis of 105 female cases (mean: 72 years, range: 55–93 years) from a tertiary hospital in China (facility A, FA). The patients with back and/or leg pain were referred for a spine X-ray. The images were retrieved and transferred to a central reading facility (facility B, FB), where images were double-read by two readers experienced in evaluating osteoporotic vertebral compressive deformity (VCD)/VCF. A qualitative VCD with <20%, 20–25%, 25–40%, and >40% vertebral body height loss was recorded as minimal, mild, moderate, and severe grades, respectively. A VCD coexisted with endplate/cortex fracture (ECF) was VCF. FB readings were considered as the reference. RESULTS: There were 34 true negative cases where FA and FB had a consensus. In 7 cases with minimal VCD, 3 cases with ECF, and 7 cases with minimal or mild VCFs, the FA readings were false negative. No standalone singular moderate or severe VCD/VCF in a patient was missed in FA's reports. In 25 FA reading positive cases with multiple VCFs, one VCF was missed in 8 cases, more than one VCF was missed in 15 cases, and one additional ECF was missed in 2 cases. In 14 cases, FA and FB had VCF number agreement, with the term ‘vertebral fracture’ was used appropriately in FA reports. In 15 cases, FA and FB had agreement in VCF number; however, the appropriate term ‘vertebral fracture’ was not used in FA reports; instead the terms of ‘compressive change’ or ‘wedging change’ were used. In most VCFs, severity grading was not given in FA. In 13 VCFs where grading was reported, all were marked as ‘mild’, including seven mild VCFs, five moderate VCFs, and even one severe VCF. CONCLUSION: Among the patients with VCD/VCF, the false negative rate among was 23.9% (17/71), but the missed cases were all minimal or mild grades. One or more VCFs were missed in 32.4% (23/71) of the cases with multiple VCFs. Appropriate severity grading was not reported for most cases. THE TRANSLATIONAL POTENTIAL OF THIS ARTICLE: The underreporting rate of osteoporotic vertebral compressive fracture in back pain clinic patients in a typical tertiary hospital setting in China compared favorably with literature reports. However, there is a general lack of awareness of vertebral endplate/cortex fracture sign and vertebral fracture severity grading, while minimal and mild VCD with endplate/cortex fracture may have clinical significance. Moreover, after one VCF is spotted in a patient, it is highly advisable to carefully check the whole spine so that multiple VCFs will not be missed. Chinese Speaking Orthopaedic Society 2019-11-09 /pmc/articles/PMC7452293/ /pubmed/32913707 http://dx.doi.org/10.1016/j.jot.2019.10.007 Text en © 2019 The Author(s) http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). |
spellingShingle | Original Article Du, Mei-Mei Che-Nordin, Nazmi Ye, Pei-Pei Qiu, Shi-Wen Yan, Zhi-Han Wang, Yi Xiang J. Underreporting characteristics of osteoporotic vertebral fracture in back pain clinic patients of a tertiary hospital in China |
title | Underreporting characteristics of osteoporotic vertebral fracture in back pain clinic patients of a tertiary hospital in China |
title_full | Underreporting characteristics of osteoporotic vertebral fracture in back pain clinic patients of a tertiary hospital in China |
title_fullStr | Underreporting characteristics of osteoporotic vertebral fracture in back pain clinic patients of a tertiary hospital in China |
title_full_unstemmed | Underreporting characteristics of osteoporotic vertebral fracture in back pain clinic patients of a tertiary hospital in China |
title_short | Underreporting characteristics of osteoporotic vertebral fracture in back pain clinic patients of a tertiary hospital in China |
title_sort | underreporting characteristics of osteoporotic vertebral fracture in back pain clinic patients of a tertiary hospital in china |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7452293/ https://www.ncbi.nlm.nih.gov/pubmed/32913707 http://dx.doi.org/10.1016/j.jot.2019.10.007 |
work_keys_str_mv | AT dumeimei underreportingcharacteristicsofosteoporoticvertebralfractureinbackpainclinicpatientsofatertiaryhospitalinchina AT chenordinnazmi underreportingcharacteristicsofosteoporoticvertebralfractureinbackpainclinicpatientsofatertiaryhospitalinchina AT yepeipei underreportingcharacteristicsofosteoporoticvertebralfractureinbackpainclinicpatientsofatertiaryhospitalinchina AT qiushiwen underreportingcharacteristicsofosteoporoticvertebralfractureinbackpainclinicpatientsofatertiaryhospitalinchina AT yanzhihan underreportingcharacteristicsofosteoporoticvertebralfractureinbackpainclinicpatientsofatertiaryhospitalinchina AT wangyixiangj underreportingcharacteristicsofosteoporoticvertebralfractureinbackpainclinicpatientsofatertiaryhospitalinchina |