Hip fracture management in the emergency department and its impact on hospital outcomes: A retrospective cross-sectional analysis
Document Type
Article
Publication Date
10-1-2022
Abstract
This study aims to report on the time taken to deliver crucial treatment for patients with hip fracture in the Emergency Department (ED) of a tertiary centre and identify any association between time spent in ED and hospital health outcomes. Findings Hospital hip fracture care in this ED was delivered in a timely manner. Spending >= 5 h in ED before transfer to the orthopaedic ward was associated with cardiac events and prolonged (>= 14 days) hospital stay, but not mean length of stay, discharge to care home, or in-hospital death. Message Hospital hip fracture care starts upon arrival to the ED and there are points for improvement according to international guidelines on analgetic methods and the use of specified care protocols. Purpose The emergency department (ED) plays an important role in initiating early treatment for hip fractures and ensuring prompt transfer to orthopaedic wards. This study reported on the care delivered in a tertiary centre ED in Malaysia and the association between time spent in ED with hospital outcomes. Methods Patients aged >= 65 years with fragility hip fractures and seen by the geriatric team were recruited. Data were collected on patient characteristics, key time points for treatment and hospital outcomes. Median time in ED was used to dichotomise long and short waiting time. Results 447 patients were recruited. The mean (SD) age was 80.5 (7.0) years and 69.8% were women. 74.9% were prescribed analgesia within 30 min. Median (Q1,Q3) time to diagnostic imaging was 27.0 (24.0-43.0) minutes, clinician confirmation of fracture was 83.0 (49.0-129.0) minutes, and time in ED was 4.8 (3.5-6.9) h. A weekday, weekend, in-hour or out-of-hour admission did not demonstrate a difference in the time important care was delivered. Patients who spent >= 5 h in ED had more cardiac events (4.6 vs 10.1%, p = 0.023) and more spent >= 14 days in hospital (17.5 vs 29.0%, p = 0.004) compared to those < 5 h. No significant increase in inpatient complications (43.5 vs 34.6%, p = 0.054), length of stay (median, 8 vs 7 days, p = 0.119), care home discharge (5.3 vs 4.6%, p = 0.772), or in-hospital death (6.3 vs 4.2%, p = 0.313) were observed. Conclusion Time to early hip fracture pain relief and diagnosis was adequate in this ED. Time >= 5 h in ED was associated with cardiac events and 2 weeks or more inpatient stay.
Keywords
Hip fracture, Injury, Hospital, Aged, Emergency department
Divisions
fac_med
Funders
University of Malaya Bantuan Kecil Penyelidikan(BKP) research grant
Publication Title
European Geriatric Medicine
Volume
13
Issue
5
Publisher
Springer
Publisher Location
ONE NEW YORK PLAZA, SUITE 4600, NEW YORK, NY, UNITED STATES