Natural language processing of radiology reports for the identification of patients with fracture

Background: Although risk factors for heterotopic ossification (HO) have been defined, the effect from surgical approach is not fully understood. The primary objective of our study was to evaluate the effect that surgical approach has on the risk for developing severe HO after total hip arthroplasty (THA) and compare this with other known risk factors. We hypothesized that there would be no difference in HO formation based on the surgical approach. Methods: We retrospectively reviewed all patients who underwent primary THA at our hospital between March 2011 and March 2021. Patients with HO documented in the radiology reports were crossreferenced with our THA data set and manually reviewed to determine Brooker classification. Patient demographics, medical comorbidities, surgical details, and medication information were collected from the electronic medical record and compared. Results: Of 3,427 patients who underwent THA, 677 (19.8%) developed HO postoperatively. A multivariable analysis confirmed that surgical approach was independently associated with increased odds for HO development. The anterolateral (odds ratio [OR], 3.43; P , 0.001) and posterior (OR, 2.24; P , 0.001) approaches had increased odds for developing HO compared with the direct anterior approach. However, only the anterolateral approach (OR, 1.85; P = 0.033) demonstrated an increased association with the development of severe HO (Brooker 3, 4) postoperatively. Conclusion: Although the use of the direct anterior approach had the lowest overall OR for developing HO after THA, this is likely only clinically notable when compared with the anterolateral approach. Level of evidence: III H eterotopic ossification (HO) formation is a common occurrence after total hip arthroplasty (THA), historically reported in up to 50% of patients. [1][2][3][4] Although most cases are mild, severe HO development may affect patient outcomes such as hip range of motion and walking

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“…Although this methodology has previously been validated, it is possible that this underestimated the true incidence of HO. 15,16,29…”

Section: Discussionmentioning

confidence: 99%

Is Heterotopic Ossification Associated With Surgical Approach in Total Hip Arthroplasty?

Wilke

Guier

Applewhite

et al. 2023

J Am Acad Orthop Surg

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“…Similar artificial intelligence (AI)‐based systems for fracture identification have gained recent attention. ( 41 )…”

Section: Discussionmentioning

confidence: 99%

The Sydney AFF Score: A Simple Tool to Distinguish Females Presenting With Atypical Femur Fractures Versus Typical Femur Fractures

Crouch

Dhanekula

Burn

et al. 2020

Journal of Bone and Mineral Research

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Atypical femur fractures (AFF) are a rare but serious complication of long‐term bisphosphonate use. Although clearly defined by ASBMR criteria, a proportion of patients with AFFs may go unrecognized and the use of qualitative fracture criteria may lead to uncertainty in AFF diagnosis, with significant therapeutic implications. A score that rapidly and accurately identifies AFFs among subtrochanteric femur fractures using quantitative, measurable parameters is needed. In a retrospective cohort of 110 female patients presenting with AFFs or typical femur fractures (TFFs), multiple logistic regression and decision tree analysis were used to develop the Sydney AFF score. This score, based on demographic and femoral geometry variables, uses three dichotomized independent predictors and adds one point for each: (age ≤80 years) + (femoral neck width <37 mm) + (lateral cortical width at lesser trochanter ≥5 mm), (score, 0 to 3). In an independent validation set of 53 female patients at a different centre in Sydney, a score ≥2 demonstrated 73.3% sensitivity and 69.6% specificity for AFF (area under the receiver‐operating characteristic curve [AUC] 0.775, SE 0.063) and remained independently associated with AFF after adjustment for bisphosphonate use. The Sydney AFF score provides a quantitative means of flagging female patients with atraumatic femur fractures who have sustained an AFF as opposed to a TFF. This distinction has clear management implications and may augment current ASBMR diagnostic criteria. © 2021 American Society for Bone and Mineral Research (ASBMR).

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“…Patients identified using NLP were then verified by review of lumbar spine imaging, using methodology as previously described. [22][23][24] Out of 352 patients, 294 (84%) underwent a lumbar spine fusion prior to the total hip replacement. These patients were included in the final analysis.…”

Section: Methodsmentioning

confidence: 99%

Direct anterior approach associated with lower dislocation risk after primary total hip arthroplasty in patients with prior lumbar spine fusion

et al. 2023

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Background: While there has been much interest in the increased dislocation rate in total hip arthroplasty (THA) patients with a lumbar spine fusion (LSF), there is minimal literature comparing the risk based on surgical approach. The purpose of this study was to determine if a direct anterior (DA) approach was protective against dislocation when compared to the anterolateral and posterior approaches in this high-risk patient population. Methods: A retrospective review was performed of 6554 THAs performed at our institution from January 2011 to May 2021. 294 (4.5%) patients had a prior LSF and were included in the analysis. The surgical approach, timing of LSF in relation to THA, vertebral levels fused, timing of THA dislocation, and the need for revision surgery were recorded for statistical analysis. Results: In total, 39.7.3% of patients underwent a DA approach (n = 117), 25.9% underwent an anterolateral approach ( n = 76), and 34.3% underwent a posterior approach ( n = 101). There was no difference in number of vertebral levels fused between groups (mean 2.5, all p > 0.05). There was a total of 13 (4.4%) THA dislocation events, with an average time from surgery to dislocation of 5.6 months (0.3–30.5 months). There were fewer dislocations in the DA cohort (0.9%) in comparison to both the anterolateral (6.6%, p = 0.036) and posterior groups (6.9%, p = 0.026). Conclusions: The DA approach demonstrated a significantly lower THA dislocation rate compared to both the anterolateral and posterior approaches in patients with a concomitant LSF.

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Natural language processing of radiology reports for the identification of patients with fracture

Cited by 24 publications

References 27 publications

Is Heterotopic Ossification Associated With Surgical Approach in Total Hip Arthroplasty?

Is Heterotopic Ossification Associated With Surgical Approach in Total Hip Arthroplasty?

The Sydney AFF Score: A Simple Tool to Distinguish Females Presenting With Atypical Femur Fractures Versus Typical Femur Fractures

Direct anterior approach associated with lower dislocation risk after primary total hip arthroplasty in patients with prior lumbar spine fusion

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