Implementation of a fracture and dislocation registry. Epidemiology and scoring validity of long-bone fractures

Abstract

Introduction: The Fracture and Dislocation Registry of Stavanger University Hospital were initiated 1st of January 2004 to accomplish the request of reliable data regarding incidence, modes of treatment and outcome of fractures. To ensure good quality in the registry the data have been consecutively controlled. To prepare the registry for further research the most important parameter, the classification code was validated. Method: All inpatient primary and secondary treatments of fractures made at the operation theatre were classified and reported by the surgeons consecutively. The most important parameters were; the AO/OTA- and Gustilo/Anderson-classification, the method of fixation, and the reasons for the reoperations. The surgeons recoded the fractures during the intra- and inter-rater analyses. A reference code dataset was made for accuracy assessment. Results: All involved surgeons reported to the registry. Completeness has been excellent. Approximately 28 % of the long bone fractures that was diagnosed inhospitally or at the Emergency Department were treated in the operation theatre. The overall incidence per 100,000 per year was 406 with a 95% confidence interval (95%CI) of 395–417. The male:female ratio was 2:1 among those <50 years, and 1:3 in those ≥50 years. The accuracy of (four sign of) the AO/OTA classification was for adult fractures; kappa agreement of 0.68 (95% CI: 0.65–0.71) and for children’s fractures Κ=0.72 (95% CI: 0.64-0.79) and PA 76%. Fracture type, frequency of the fracture, and segment fractured significantly influenced accuracy, whereas the coder’s experience did not. Conclusion: The implementation of the Fracture and Dislocation Registry has been made successfully. Maintenance of the registry is assured by the controller through the features of the electronic database program. The classification according to AO/OTA classification (= Müller classification) seems to be satisfactory reliable. The registry seems to be well prepared for contribution to quality assurance and improvements in fracture treatment.