The management of patients admitted to hospital with vertebral fragility fractures: Experience from a UK university hospital
Document Type
Article
Publication Date
10-1-2021
Abstract
Introduction: Patients that require hospital admission for vertebral fragility fractures were older, multimorbid, frail, have cognitive impairment and were in severe pain. This study aimed to describe the hospital treatment received in one UK university hospital with the purpose of proposing what hospital services should look like. Method: This was an observational study of adults aged 50 years and over admitted to hospital over 12 months with an acute vertebral fragility fracture. Information was collected from patients and electronic health records on their presentation and hospital care. Results: 90 patients were recruited into the study. 69% presented to hospital 24 h after the onset of their severe acute back pain. 38% had a concomitant medical diagnosis, such as an ongoing infection. Xray of the spine was the most common imaging of choice to diagnose a fracture. There was variation in the content of the radiology reports. 46% or patients were managed on geriatric medicine wards, 39% on general medical wards, and followed by 14% on spinal surgical wards. Patients cared for by medical teams were older, frailer, had a higher prevalence of cognitive impairment, more dependent for daily living and less mobile compared to those under the care of the spinal surgical team. Many patients on medical wards had input from spinal surgical team and vice versa. 9% proceeded to have vertebral augmentation. Despite many in severe pain, only a third were prescribed opioids with the median dose of morphine equivalent was 10-20 mg daily for the first three days of admission. While in hospital, 31% developed a medical complication, with infection being the most common one. On discharge, 76% still required opioids and only 56% had a plan for their bone health. Discussion: Improvements could be made to hospital vertebral fracture care. Many did not receive adequate pain relief and appropriate assessments to reduce their future fall and fracture risk. Most were medically managed. Quality standards and re-organising care in hip fracture has led to improved outcomes. A similar approach in vertebral fragility fractures might also deliver improved outcomes. (c) 2021 Elsevier Ltd. All rights reserved.
Keywords
Vertebral fracture, Aged, Hospital, Osteoporosis
Divisions
fac_med
Funders
Healthcare for Older People research office team,Dunhill Medical Trust (RTF49/0114)
Publication Title
Injury - International Journal of the Care of the Injured
Volume
52
Issue
10
Publisher Location
THE BOULEVARD, LANGFORD LANE, KIDLINGTON, OXFORD OX5 1GB, OXON, ENGLAND