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Open Access Publications from the University of California

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

  • Author(s): Casey, Scott D.
  • Stevenson, Dane E.
  • Mumma, Bryn E.
  • Slee, Christina
  • Wolinsky, Philip R.
  • Tyler, Katren
  • Hirsch, Calvin H.
  • et al.

Introduction: Over 300,000 patients in the United States sustain low-trauma fragility hip fracturesannually. Multidisciplinary geriatric fracture programs (GFP) including early, multimodal painmanagement reduce morbidity and mortality. Our overall goal was to determine the effects of a GFPon the emergency department (ED) pain management of geriatric fragility hip fractures.

Methods: We performed a retrospective study including patients age ≥65 years with fragility hipfractures two years before and two years after the implementation of the GFP. Outcomes were timeto (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 toevaluate 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% confidenceinterval [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 (103vs. 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 forgeriatric patients with fragility hip fractures. Future studies should evaluate the effects of thesechanges in pain management on longer-term outcomes.

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