Various research methods have been used to obtain skeletal fracture data and report the incidence of fractures. A large number of British studies have used data collected in emergency departments, and not data derived from orthopaedic units. We hypothesised that fracture data will differ depending upon the methodology employed to capture it. Two commonly used sources of fracture data at our institution were compared, (the Emergency Department (ED) database and the Orthopaedic Trauma Unit (OTU) database), using a cohort of adult patients from our defined population as the study sample. We performed univariate analyses to identify differences between groups with accurate and inaccurate ED fracture diagnoses. We then performed a binary logistic regression analysis to determine the best predictors of diagnostic accuracy. In one year, 7,449 patients were referred to the OTU. Three-quarters were referred with fractures. The overall false positive fracture referral rate was 25%. Several fracture subtypes were commonly overdiagnosed in the ED. Regression analysis showed that patient age, patient gender, and the seniority of the referring clinician were independently predictive of an accurate fracture diagnosis. We suggest that studies making use of ED fracture data may potentially overestimate the incidence of adult fractures. 1. Introduction The systematic collection and analysis of skeletal fracture data is the essence of fracture epidemiology. Its application to clinical practice allows clinicians to compare affected with unaffected patient groups, determine definable and preventable characteristics that predispose to skeletal fracture, and ensure the provision of appropriate treatment strategies. Cummings et al. [1], in their review of the methodological challenges facing all injury epidemiologists, identified several key areas including the definition and classification of injuries and the importance of defining the population at risk. The analysis of fracture data can only occur if fractures are identified accurately. This process relies upon the ability of clinicians to make clinical judgements and accurately interpret standard plain radiographs. It has been suggested that experienced clinicians are able to identify fractures with greater accuracy than those less experienced [2, 3]. In adult patients, only a small number of studies have analysed the incidence of fractures in a given population. Reported rates vary considerably, with Donaldson et al. [4] suggesting a rate four times higher than Brinker and O’Connor [5] (36.0/1000/yr versus 8.5/1000/yr).
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