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BET 2: CT versus MRI for occult hip fractures
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  • Published on:
    Response to Matthew. L Khan-Dyer
    • Bernard A Foex, Consultant in Emergency Medicine and Critical Care Manchester Royal Infirmary
    • Other Contributors:
      • Anna Russell, ST3 Emergency Medicine

    We do not disagree with the comment, hence our conclusion that, “CT is a valid first line imaging technique in suspected occult hip fracture and is easily accessible in most centres.” The intention of the BET was to present evidence on whether one modality was better than the other and so we looked for studies comparing the two imaging techniques. The study by Thomas et al. forms part of the evidence that CT scanning is a valid method of detecting occult hip fractures and so was not included in the table of evidence.
    Thomas RW, Williams HLM, Carpenter EC, Lyons K. The validity of investigating occult hip fractures using multidetector CT. Br J Radiol

    Conflict of Interest:
    None declared.
  • Published on:

    I read this article with interest as I am currently launching a QUIP on this exact subject.

    As a declaration of possible bias I am looking to use highly sensitive CTs to screen off negative findings to frailty services and thus avoiding orthopaedic beds.

    I am surprised that more credence was not given to the study by Thomas et al. who's sensitivity and specificity was 100% for ct. The study is one that clearly identifies MDCT as the protocol of choice when identifying occult hip fractures. I am not sure whether this is directly comparable to other studies in this way, and therefore some doubt exists as to whether current discrepancies in reporting are more attributable to the scanning protocol used.

    I feel that the current nice guidelines are out of date with modern CT scanning and is having undue influence on first line diagnostics of occult hip fractures.

    I do appreciate the move forward for CT scanning hips as first line diagnostics thus cutting bed-days/patient, expediting correct treatment and improving patient experience.

    Conflict of Interest:
    None declared.