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. 2017 Jun;18(4):585-591.
doi: 10.5811/westjem.2017.3.32853. Epub 2017 Apr 19.

Emergency Department Pain Management Following Implementation of a Geriatric Hip Fracture Program

Scott D Casey  1 , Dane E Stevenson  1 , Bryn E Mumma  1 , Christina Slee  2 , Philip R Wolinsky  3 , Calvin H Hirsch  4 , Katren Tyler  1
Affiliations

Emergency Department Pain Management Following Implementation of a Geriatric Hip Fracture Program

Scott D Casey et al. West J Emerg Med. 2017 Jun.

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.

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Conflict of interest statement

Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. No author has professional or financial relationships with any companies that are relevant to this study. There are no conflicts of interest or sources of funding to declare.

Figures

Figure 1
Figure 1
Time to first analgesic in minutes before and after implementation of a geriatric fracture program (GFP).
Figure 2
Figure 2
Intravenous (IV) morphine equivalents (mg) before and after implementation of a geriatric fracture program (GFP).
See this image and copyright information in PMC

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