ACR Appropriateness Criteria® Acute Hip Pain: 2024 Update

Abstract

Acute hip pain can be related to any combination of hip fracture, dislocation, and/or soft tissue injury. These injuries require timely diagnosis to avoid associated complications, such as osteonecrosis or prolonged immobility. Imaging plays a crucial role in the evaluation of these injuries, noting that hip fractures cannot be reliably diagnosed or excluded via physical examination alone. Radiographs are the initial imaging modality of choice for acute hip pain. Several recent studies have evaluated specific scenarios in which cross-sectional imaging (CT and/or MRI) should also be obtained—these scenarios will be reviewed as separate variants within this document.

The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.