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. 2019 May 1;9(4):e028537.
doi: 10.1136/bmjopen-2018-028537.

Rationale and design of the HIP fracture Accelerated surgical TreaTment And Care tracK (HIP ATTACK) Trial: a protocol for an international randomised controlled trial evaluating early surgery for hip fracture patients

Flavia K Borges  1 , Mohit Bhandari  2 , Ameen Patel  3 , Victoria Avram  2 , Ernesto Guerra-Farfán  4 , Alben Sigamani  5 , Masood Umer  6 , Maria Tiboni  3 , Anthony Adili  2 , John Neary  3 , Vikas Tandon  3 , Parag K Sancheti  7 , AbdelRahman Lawendy  8 , Richard Jenkinson  9   10 , Mmampapatla Ramokgopa  11   12 , Bruce M Biccard  13 , Wojciech Szczeklik  14 , Chew Yin Wang  15 , Giovanni Landoni  16   17 , Patrice Forget  18 , Ekaterine Popova  19 , Gavin Wood  20 , Aamer Nabi Nur  21 , Bobby John  22 , Paweł Ślęczka  23 , Robert J Feibel  24 , Mariano Balaguer-Castro  25 , Benjamin Deheshi  26 , Mitchell Winemaker  2 , Justin de Beer  2 , Richard Kolesar  27 , Jordi Teixidor-Serra  4 , Jordi Tomas-Hernandez  4 , Michael McGillion  28 , Harsha Shanthanna  27 , Iain Moppett  29 , Jessica Vincent  1 , Shirley Pettit  1 , Valerie Harvey  1 , Leslie Gauthier  30 , Kim Alvarado  28 , P J Devereaux  1   31
Affiliations

Rationale and design of the HIP fracture Accelerated surgical TreaTment And Care tracK (HIP ATTACK) Trial: a protocol for an international randomised controlled trial evaluating early surgery for hip fracture patients

Flavia K Borges et al. BMJ Open. .

Abstract

Introduction: Annually, millions of adults suffer hip fractures. The mortality rate post a hip fracture is 7%-10% at 30 days and 10%-20% at 90 days. Observational data suggest that early surgery can improve these outcomes in hip fracture patients. We designed a clinical trial-HIP fracture Accelerated surgical TreaTment And Care tracK (HIP ATTACK) to determine the effect of accelerated surgery compared with standard care on the 90-day risk of all-cause mortality and major perioperative complications.

Methods and analysis: HIP ATTACK is a multicentre, international, parallel group randomised controlled trial (RCT) that will include patients ≥45 years of age and diagnosed with a hip fracture from a low-energy mechanism requiring surgery. Patients are randomised to accelerated medical assessment and surgical repair (goal within 6 h) or standard care. The co-primary outcomes are (1) all-cause mortality and (2) a composite of major perioperative complications (ie, mortality and non-fatal myocardial infarction, pulmonary embolism, pneumonia, sepsis, stroke, and life-threatening and major bleeding) at 90 days after randomisation. All patients will be followed up for a period of 1 year. We will enrol 3000 patients.

Ethics and dissemination: All centres had ethics approval before randomising patients. Written informed consent is required for all patients before randomisation. HIP ATTACK is the first large international trial designed to examine whether accelerated surgery can improve outcomes in patients with a hip fracture. The dissemination plan includes publishing the results in a policy-influencing journal, conference presentations, engagement of influential medical organisations, and providing public awareness through multimedia resources.

Trial registration number: NCT02027896; Pre-results.

Keywords: accelerated surgery; hip fracture; randomised control trial.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
The HIP ATTACK RCT flow chart. ECG, electrocardiogram; HIP ATTACK, HIP fracture Accelerated surgical TreaTment And Care tracK; NPO, nil per os; OR, operating room; RCT, randomised controlled trial.
See this image and copyright information in PMC

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