Geriatric Emergency Research Unit, Emergency Department, Vajira Hospital, Navamindradhiraj University, Dusit, Bangkok, Thailand.
Emergency Department, Vajira Hospital, Navamindradhiraj University, Dusit, Bangkok, Thailand.
Clin Interv Aging. 2024 Jul 3;19:1225-1233. doi: 10.2147/CIA.S465006. eCollection 2024.
This study aimed to evaluate the impact of the Hip Fracture Fast-Track (HFFT) protocol, designed specifically for older patients at our hospital, which commenced on January 1, 2022, on the management of emergency department (ED) pain in older adults with hip fractures.
Retrospective pre- and post-study data from electronic health records (EHR) at our hospital, using the International Classification of Diseases (ICD)-10 codes S72.0, S72.1, S72.8, and S72.9, were utilized. The study included patients aged 65 years or older who presented to the ED with low-energy, non-pathologic isolated hip fractures or proximal femur fractures. The pre-HFFT period included patients from January 1, 2020, to December 31, 2021, and the post-HFFT period included patients from January 1, 2022, to October 31, 2023. Data were compared for the proportion of patients undergoing pain evaluation in the ED, before discharge, time to first analgesia, number of patients receiving pain relief in the ED, and the use of fascia iliaca compartment blocks (FICBs) and pericapsular nerve group blocks (PENGBs).
The final analysis involved 258 patients, with 116 in the pre-protocol group and 142 in the post-protocol group. The rate of analgesic use increased significantly in the post-HFFT group (78 [67.24%] vs 111 [78.17%], P = 0.049). The rate of pain score screening at triage increased from 51.72% before the HFFT protocol to 86.62% post-HFFT protocol (p < 0.001). Compared with the pre-HFFT protocol, the post-HFFT protocol exhibited a higher rate of FICB (0% vs 14.08%, p < 0.001) and PENGB (0% vs 5.63%, p = 0.009) administration.
The HFFT protocol's implementation was associated with improved ED pain evaluation and analgesic administration in older adults with hip fractures. These findings indicate that tailored protocols, such as the HFFT, hold promise for enhancing emergency care for this vulnerable population.
本研究旨在评估我们医院专门为老年患者设计的 Hip Fracture Fast-Track（HFFT）方案对急诊科（ED）老年髋部骨折患者疼痛管理的影响。
我们使用医院电子健康记录（EHR）中的国际疾病分类（ICD）第 10 版代码 S72.0、S72.1、S72.8 和 S72.9 进行回顾性研究。该研究纳入了年龄在 65 岁及以上的因低能量、非病理性孤立性髋部骨折或股骨近端骨折而到急诊科就诊的患者。HFFT 前时期包括 2020 年 1 月 1 日至 2021 年 12 月 31 日的患者，HFFT 后时期包括 2022 年 1 月 1 日至 2023 年 10 月 31 日的患者。比较两组患者在急诊科接受疼痛评估的比例、出院前首次镇痛的时间、在急诊科接受疼痛缓解的患者数量，以及使用骼筋膜间隙阻滞（FICB）和囊周神经群阻滞（PENGB）的情况。
最终分析纳入了 258 例患者，其中 116 例患者在方案前组，142 例患者在方案后组。在方案后组，镇痛药物使用率显著升高（78[67.24%]比 111[78.17%]，P=0.049）。HFFT 方案实施后，急诊科分诊时疼痛评分筛查率从 51.72%增加到 86.62%（p<0.001）。与 HFFT 方案前相比，方案后组 FICB（0%比 14.08%，p<0.001）和 PENGB（0%比 5.63%，p=0.009）使用率更高。
HFFT 方案的实施与髋部骨折老年患者 ED 疼痛评估和镇痛药物管理的改善有关。这些发现表明，像 HFFT 这样的定制方案有可能改善对这一脆弱人群的急诊护理。
