We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Emergency Department Pain Management Following Implementation of a Geriatric Hip Fracture Program.
- Authors
Casey, Scott D.; Stevenson, Dane E.; Mumma, Bryn E.; Slee, Christina; Wolinsky, Philip R.; Hirsch, Calvin H.; Tyler, Katren
- Abstract
Introduction: 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. Methods: 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. Results: 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. Conclusion: 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.
- Subjects
UNITED States; INTRANASAL medication; CONFIDENCE intervals; STATISTICAL correlation; CROWDS; FISHER exact test; BONE fractures; FRAIL elderly; HIP joint injuries; HOSPITAL emergency services; LONGITUDINAL method; REGRESSION analysis; STATISTICS; PAIN management; MULTIPLE regression analysis; CHANGE management; MEDICAL records; RETROSPECTIVE studies
- Publication
Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health, 2017, Vol 18, Issue 4, p585
- ISSN
1936-900X
- Publication type
Article
- DOI
10.5811/westjem.2017.3.32853