EP 747 Pre-operative Chest X-rays in Hip Fracture Patients - Adherence, Outcomes, and Improvements

Introduction and Aim

Hip fractures constitute a significant proportion of orthopaedic admissions. This demographic is often frail, with limited physiological reserves and increased susceptibility to prolonged hospital stays.

Post-operative pneumonia is a common occurrence and is associated with higher mortality rates. An initial plain film radiograph of the chest (CXR) provides a baseline and useful reference in the management of post-op pneumonia.

Method

Retrospective review of all hip fracture patients in our DGH through September and October 2025. The frequency of a baseline CXR was measured and assessed against the incidence of future CXRs later in admission.

Results

84 patients were seen for hip fractures. 65/84 (77.4%) had a baseline CXR, with 24 of these patients showing findings on their baseline CXR. When excluding chronic conditions, 10/65 (15.4%) showing acute findings which contributed to management plans.

19/84 (22.6%) did not have a baseline CXR. CXRs were requested later during the inpatient stay for 10 of these patients. Two new acute findings were detected, with one patient being found to have new cardiomegaly, and the other a lobar collapse.

Conclusions

A significant number of treatable pathologies were identified on admission. More than half of patients without a baseline CXR were later scanned. A baseline would offer useful reference when assessing for new changes.

Further review of whether these patients underwent investigation for pulmonary embolism would be a useful step. CXRs are often indicated prior to cross-sectional imaging and the absence of this would likely add delay to this process.