title: ACR appropriateness criteria acute hip pain-suspected fracture.
abstract: Substantial cost, morbidity, and mortality are associated with acute proximal femoral fracture and may be reduced through an optimized diagnostic imaging workup. Radiography represents the primary diagnostic test of choice for the evaluation of acute hip pain. In middle aged and elderly patients with negative radiographs, the evidence indicates MRI to be the next diagnostic imaging study to exclude a proximal femoral fracture. CT, because of its relative decreased sensitivity, is only indicated in patients with MRI contraindications. Bone densitometry (DXA) should be obtained in patients with fragility fractures. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
authors.affiliation: Tufts Medical Center, Boston, Massachusetts. Electronic address: robwardmd@gmail.com.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Ward
authors.affiliation: Brigham & Women's Hospital, Boston, Massachusetts.
authors.forename: Barbara N
authors.initials: BN
authors.lastname: Weissman
authors.affiliation: Mayo Clinic, Jacksonville, Florida.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Kransdorf
authors.affiliation: NYU Center for Musculoskeletal Care, New York, New York.
authors.forename: Ronald
authors.initials: R
authors.lastname: Adler
authors.affiliation: Warwick Valley Orthopedic Surgery, Warwick, New York, American Academy of Orthopaedic Surgeons.
authors.forename: Marc
authors.initials: M
authors.lastname: Appel
authors.affiliation: Florida Hospital, Orlando, Florida.
authors.forename: Laura W
authors.initials: LW
authors.lastname: Bancroft
authors.affiliation: Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania.
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Bernard
authors.affiliation: Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Bruno
authors.affiliation: Bone, Spine and Hand Surgery, Chartered, Brick, NJ, American Academy of Orthopaedic Surgeons.
authors.forename: Ian Blair
authors.initials: IB
authors.lastname: Fries
authors.affiliation: Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
authors.forename: William B
authors.initials: WB
authors.lastname: Morrison
authors.affiliation: Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Mosher
authors.affiliation: Mayo Clinic, Phoenix, Arizona.
authors.forename: Catherine C
authors.initials: CC
authors.lastname: Roberts
authors.affiliation: Lenox Hill Hospital, New Rochelle, New York, Society of Nuclear Medicine.
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Scharf
authors.affiliation: University of Wisconsin Hospital, Madison, Wisconsin.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Tuite
authors.affiliation: Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
authors.forename: Adam C
authors.initials: AC
authors.lastname: Zoga
mesh_terms: D059787:Acute Pain / Q000175:diagnosis* / Q000209:etiology; D018771:Arthralgia / Q000175:diagnosis* / Q000209:etiology; D003952:Diagnostic Imaging / Q000592:standards*; D005265:Femoral Neck Fractures / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D009985:Orthopedics / Q000592:standards*; D017410:Practice Guidelines as Topic; D011871:Radiology / Q000592:standards*; D014481:United States
keywords: Appropriateness criteria; CT; MRI; bone densitometry; hip fracture; osteoporosis