Timing and modalities of access to the emrgency department for patients with fragility fractures: differences among Northern, Central and Southern Italy

Introduction. The increased risk of falling leads to an increased incidence of fragility fractures in osteoporotic patients. The timing and mode of access to the emergency room (E.R.) vary greatly among individuals that incur in a fall. The aim of our study is to evaluate these differences according to data from the North, Central and Southern Italy. Materials and methods. During 2011 we conducted a national epidemiological survey INDACO 3, on behalf of SIOT, involving 95 Italian trauma centres. We asked each centre to collect data on patients ≥ 55 years of age with a fragility fracture. For each patient they had to administer a form including questions on various aspects of their medical history: age, sex, reason for visit, fracture type, time spent since the fall to the access in the emergency room, access mode (their own resources or ambulances). Results. Of 1,786 patients recruited, most were females (80.74%). The mean age was 76.38 y.o. (SD ± 9.12). The mean BMI was 25.72 kg/m² (SD ± 3.97). The percentages of patients who sustained a hip fracture and reached the E.R. with an ambulance were respectively 92%, 87%, and 84% in the North, Centre, and South of Italy. As for those who sustained a humerus fracture, the percentages were respectively 31%, 44%, and 25% in the North, Centre, and South of Italy. As for wrist fractures the percentages were respectively 20%, 15%, and 7% in the North, Centre, and South of Italy. Most of patients reach the E.R. within the first 12 hours, independently of the site of the fracture and the geographic field. Conclusions. The data show that the subjects with hip and multiple fractures arrive to the emergency room mostly by ambulance and within 12 hours. The subjects with humerus and wrist fractures, which have a greater likelihood of being undiagnosed, go there with their own resources and within 12 hours. Data indicate no significant differences between North, Central and Southern Italy. Bibliography 1. WHO Technical Report Series, No. 843. Assessment of fracture risk and its application to screening for post-menopausal osteoporosis. Geneva: World Health Organization; 1994. 2. Cummings SR, Melton J III. Epidemiology and outcome of osteoporotic fractures. Lancet 2002; 359: 1761-1766.