O2087: Hospital Acquired Fractures

Background: Pediatric fragility fractures are found in association with inherited connective tissue defects or secondary osteoporosis from neuromuscular disorders. A subsection of patients with fragility fractures are found in association with chronic or critical illness. Chronic and critical illness creates risk factors for diminished bone strength placing these patients at a high likelihood of hospitalization. This overlap inevitably means that some patients will sustain fractures during routine care or activity while hospitalized. Identifying the patients at high likelihood to have fragility fractures is critical for guiding institutional prevention programs. Describing the fracture type and location is also important for the patient safety and event reporting investigations that often follow when an injury occurs in a hospitalized patient. Despite the importance of a hospital-associated fracture, relatively little has been reported on these adverse events. This study seeks to increase the sample of patients represented in published literature and expand on the clinical characteristics of the patients who experience in hospital fractures.

Methods: We retrospectively identified admissions from July 2011 through August 2024 and reviewed patients who experienced a fracture while hospitalized at a single tertiary care center in an urban environment. Patients were identified based on an initial ICD-10 code mentioning "fracture" dated within a patient's admission window. The medical record was manually reviewed to verify fracture morphology and total fracture burden along with medical history, medications, and laboratory results.

Results: There were 56 patients that met inclusion criteria with a total of 174 fractures. The most common fracture location was the ribs (n=64) followed by the Humerus (n=30). The most common fracture type was nondisplaced. Fifty-three (94.6%) of the patients were between 0 and 24 months at time of admission (median 0 months, mean of 2.7 months). There were 6 patients older than 2 years of age (median 16 years, mean 9.3 years). Forty-six patients (82.1%) had a history of administration of a medication known to adversely affect bone strength during their admission prior to the index fracture being identified. Time between admission and first identified fracture was 69 days on average. Fifty-four (96.4%) of patients required intermediate level care or higher during the course of their admission.

Conclusion: Hospitalized patients most at risk for an in-hospital fracture tend to be younger, be medically complex, admitted to an intensive or intermediate care unit, have a history of receiving medications that have the potential to negatively impact bone health, and have a prolonged hospitalization. An institutional policy directed at enacting fragile cares for patients meeting these criteria may limit in-hospital fractures as an adverse event.