Recommendation ID
CG124/1
Question
Imaging options in occult hip fracture:- In patients with a continuing suspicion of a hip fracture but whose radiographs are normal, what is the clinical and cost effectiveness of computed tomography (CT) compared to magnetic resonance imaging (MRI), in confirming or excluding the fracture?
Any explanatory notes
(if applicable)
Why this is important:- NICE's decision to recommend computed tomography (CT) over a radionuclide bone scan as an alternative to magnetic resonance imaging (MRI) to detect occult hip fractures reflects current NHS practice but assumes that advances in technology have made the reliability of CT comparable with that of MRI. If modern CT can be shown to have similar reliability and accuracy to MRI, then this has considerable implications because of its widespread availability out of hours and lower cost. It is therefore a high priority to confirm or refute this assumption by direct randomised comparison. The study design would need to retain MRI as the ‘gold standard’ for cases of uncertainty and to standardise the criteria, expertise and procedures for radiological assessment. Numbers required would depend on the degree of sensitivity and specificity (the key outcome criteria) set as target requirement for comparability, but need not necessarily be very large.

Source guidance details

Comes from guidance
Hip fracture: management
Number
CG124
Date issued
June 2011

Other details

Is this a recommendation for the use of a technology only in the context of research? No  
Is it a recommendation that suggests collection of data or the establishment of a register?   No