Casey Scott D, Stevenson Dane E, Mumma Bryn E, Slee Christina, Wolinsky Philip R, Hirsch Calvin H, Tyler Katren
University of California, Davis School of Medicine, Department of Emergency Medicine, Sacramento, California.
UC Davis Medical Center, Department of Quality and Safety, Sacramento, California.
West J Emerg Med. 2017 Jun;18(4):585-591. doi: 10.5811/westjem.2017.3.32853. Epub 2017 Apr 19.
Over 300,000 patients in the United States sustain low-trauma fragility hip fractures annually. Multidisciplinary geriatric fracture programs (GFP) including early, multimodal pain management reduce morbidity and mortality. Our overall goal was to determine the effects of a GFP on the emergency department (ED) pain management of geriatric fragility hip fractures.
We performed a retrospective study including patients age ≥65 years with fragility hip fractures two years before and two years after the implementation of the GFP. Outcomes were time to (any) first analgesic, use of acetaminophen and fascia iliaca compartment block (FICB) in the ED, and amount of opioid medication administered in the first 24 hours. We used permutation tests to evaluate differences in ED pain management following GFP implementation.
We studied 131 patients in the pre-GFP period and 177 patients in the post-GFP period. In the post-GFP period, more patients received FICB (6% vs. 60%; difference 54%, 95% confidence interval [CI] 45-63%; p<0.001) and acetaminophen (10% vs. 51%; difference 41%, 95% CI 32-51%; p<0.001) in the ED. Patients in the post-GFP period also had a shorter time to first analgesic (103 vs. 93 minutes; p=0.04) and received fewer morphine equivalents in the first 24 hours (15mg vs. 10mg, p<0.001) than patients in the pre-GFP period.
Implementation of a GFP was associated with improved ED pain management for geriatric patients with fragility hip fractures. Future studies should evaluate the effects of these changes in pain management on longer-term outcomes.
在美国，每年有超过30万患者发生低创伤性脆性髋部骨折。包括早期多模式疼痛管理在内的多学科老年骨折项目（GFP）可降低发病率和死亡率。我们的总体目标是确定GFP对老年脆性髋部骨折患者急诊科（ED）疼痛管理的影响。
我们进行了一项回顾性研究，纳入了在GFP实施前两年和实施后两年内年龄≥65岁的脆性髋部骨折患者。观察指标包括首次使用（任何）镇痛药的时间、在急诊科使用对乙酰氨基酚和髂筋膜间隙阻滞（FICB）的情况，以及在最初24小时内使用的阿片类药物剂量。我们使用置换检验来评估GFP实施后急诊科疼痛管理的差异。
我们研究了GFP实施前的131例患者和实施后的177例患者。在GFP实施后，急诊科中更多患者接受了FICB（6%对60%；差异54%，95%置信区间[CI]45 - 63%；p<0.001）和对乙酰氨基酚（10%对51%；差异41%，95%CI 32 - 51%；p<0.001）。与GFP实施前的患者相比，GFP实施后的患者首次使用镇痛药的时间也更短（103分钟对93分钟；p = 0.04），并且在最初24小时内接受的吗啡当量更少（15mg对10mg，p<0.001）。
GFP的实施与老年脆性髋部骨折患者急诊科疼痛管理的改善相关。未来的研究应评估这些疼痛管理变化对长期结局的影响。
