ACR Appropriateness Criteria^® Acute Hip Pain-Suspected Fracture

Area of Science:

• Orthopedics
• Radiology
• Geriatrics

Background:

• Acute hip pain after low-force trauma is common, especially in elderly osteoporotic individuals.
• Proximal femur or pelvis fractures are frequent causes in this demographic.
• Physical examination can be inconclusive, necessitating imaging for diagnosis.

Purpose of the Study:

• To outline diagnostic imaging strategies for acute hip pain in the elderly following low-force trauma.
• To emphasize the role of imaging when physical examination is indeterminate.
• To present evidence-based guidelines for appropriate imaging selection.

Main Methods:

• Review of current medical literature from peer-reviewed journals.
• Application of the RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation (GRADE).
• Annual review by a multidisciplinary expert panel to update the American College of Radiology Appropriateness Criteria.

Main Results:

• Radiographs are the recommended first-line imaging modality.
• Radiographs have limitations in detecting nondisplaced fractures.
• Further advanced imaging may be required for definitive diagnosis in certain cases.

Conclusions:

• Accurate diagnosis of hip fractures in the elderly relies heavily on appropriate imaging.
• Guidelines assist in selecting the most appropriate imaging tests based on clinical scenarios.
• Expert opinion may guide imaging choices when evidence is limited or equivocal.