title: A vast increase in the use of CT scans for investigating occult hip fractures.
abstract: BACKGROUND
  Early diagnosis in neck of femur fractures has been shown to improve outcome. The National Institute for Clinical Excellence recommends if an occult hip fracture is suspected then an MRI should be performed and if not available within 24h a CT should be considered. At our centre, emergency MRI is rarely available and so CT is commonly used.
  
  
  OBJECTIVE
  Our study aims to analyse the trends in CT use over a five year period for the diagnosis of neck of femur fractures.
  
  
  METHODS
  Both the number of patients with a hip fracture and those undergoing a CT hip to diagnose an occult injury were identified across two district general hospitals between 2006-2007 and 2010-2011. The time from initial radiograph to CT and initial radiograph to operation were calculated.
  
  
  RESULTS
  In 2006-2007, of 547 hip fractures, 20 CT hips were performed and 6 reported as a fractured neck of femur (30%). In 2010-2011, of 499 hip fractures, 239 CT hips were performed and 65 fractures were recognised (27%). The mean time from radiograph until CT scan was 2.0 days in 2007 and 3.2 days in 2011, which was a statistically significant difference (p<0.001). For those diagnosed using a CT scan the mean time from admission X-ray to surgery was 1.2 days in 2007 and 3.6 days in 2011.
  
  
  CONCLUSIONS
  Clinicians are becoming increasingly reliant on CT for the diagnosis of hip fractures with our data suggesting further imaging is one factor that can delay time to diagnosis and theatre.
authors.affiliation: Birmingham Heartlands Hospital, Bordesley Green, B9 5SS, United Kingdom. Robert.jordan@doctors.org.uk
authors.forename: Robert
authors.initials: R
authors.lastname: Jordan
authors.forename: Edward
authors.initials: E
authors.lastname: Dickenson
authors.forename: Daniel
authors.initials: D
authors.lastname: Westacott
authors.forename: Njalalle
authors.initials: N
authors.lastname: Baraza
authors.forename: Kuntrapka
authors.initials: K
authors.lastname: Srinivasan
mesh_terms: D000369:Aged, 80 and over; D005260:Female; D005265:Femoral Neck Fractures / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D005596:Fractures, Closed / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D006801:Humans; D008297:Male; D010818:Practice Patterns, Physicians' / Q000639:trends*; D015995:Prevalence; D012307:Risk Factors; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data* / Q000639:trends*; D006113:United Kingdom / Q000453:epidemiology; D014600:Utilization Review