Combining Register and Radiological Visits Data Allows to Reliably Identify Incident Wrist Fractures

Abstract

Purpose

To evaluate how comprehensively wrist fractures can be tracked from the national medical registers, and to propose a method for complementing the register data using time stamps of wrist radiography visits recorded in the radiological image archive.

Patients and Methods

For the Kuopio Osteoporosis Risk Factor and Prevention Study (OSTPRE) cohort of 14220 post-menopausal women, we analysed the data from the Care Register for Health Care, Register for Primary Health Care Visits, self-reports, radiological image archive PACS, and patient records to identify the wrist fractures occurred between 2011 and 2021. Using this gold standard of fractures, we validated the coverage of the registers and image archive and created algorithms to automatically identify fracture events from the registers and/or metadata of wrist radiography visits.

Results

We show that wrist fractures cannot be comprehensively identified based on national registers. To remedy this, our proposed method of combining register and image archive data can lift the coverage from 81% to 94% and reduce false discoveries from 6% to 2%.

Conclusion

The proposed method offers a more reliable way of gathering fracture information. Comprehensive fracture identification is essential in many research settings, such as incidence statistics, prevention studies, and risk assessment models.

Keywords:

• medical register
• image archive
• picture archiving and communication system
• PACS

Ethics Approval Statement

Collection of the data used in this project has been approved by a legible ethical authority. All patient data was pseudonymized and treated such that there was no risk in violating the privacy of the patients. Ownership of the data belongs to PI and collaborators. The use of the OSTPRE dataset was approved by the Kuopio University Hospital’s Ethical committee.

Acknowledgments

We thank clinical research nurse Pirkko Kanerva and research secretary Seija Oinonen for their help with the OSTPRE research data.

Disclosure

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Additional information

Funding

We acknowledge the Research Committee of the Kuopio University Hospital Catchment Area for the State Research Funding (project number 5203101). This study was also supported by Olvi Foundation, and Research Council of Finland (project 2021/338647).