Prehospital fast track care vs. accident & emergency ward for patients with hip fracture

Study Type: Therapy
OE Level of Evidence: 2
Journal Level of Evidence: N/A
Synopsis
571 elderly patients who sustained a low-energy trauma with suspected hip fracture were randomized to receive either prehospital fast track care (PFTC) or traditional emergency room (A&E) care. The purpose of this study was to determine whether a newly introduced treatment pathway (PFTC) would be more beneficial in outcomes such as time to surgery, hospital stay duration, postoperative complications, and mortality. Findings indicated no Please login to view the rest of this report. Please login to view the rest of this report.
Funding: Non-Industry funded
Sponsor: Department of Prehospital Care and the Scientific Council of Region Halland
Conflicts: None disclosed
CONTENT IS LOCKED
Why was this study needed now?
Hip fractures commonly afflict the elderly and result in a substantial burden on the healthcare system, due to the utilization of emergency services, rehabilitative care, and extended hospital stay. Complications frequently result in prolonged hospital stays that can lead to a decrease in patient quality of life and increased patient mortality. It has been suggested that a shorter time to surgery (within 24 hours of injury) may be beneficial in decreasing perioperative complications, indicating that a prehospital fast track pathway may improve patient outcomes in hip fracture care. Due to the current paucity of evidence investigating the efficacy of this care pathway, the current study was warranted.
What was the principal research question?
In the treatment of elderly patients with hip fractures, does a prehospital fast track care pathway improve time to surgery, hospital stay duration, postoperative complications, and mortality rate when compared to the conventional treatment pathway?
Population: 571 elderly patients, at least 65 years of age, with low-energy trauma and suspected hip fractures were included. A specific checklist was used for inclusion, and incorporated information pertaining to prior hip surgery, other concurrent injuries or severe illness, support for ID-bracelet, 12-Lead ECG, documentation to call the receptionist/ triage nurse, the admission nurse in the orthopaedic ward and the orthopaedic surgeon on duty. All patients were treated by the guidelines of the ambulance organization with respect to pain treatment, oxygen therapy, and intravenous fluids. Patients were excluded if there was suspicion of a head injury, symptoms of myocardial infarction, other fractures or previous surgery on the affected hip.
Intervention: Prehospital fast track care (PTFC) group: Patients in this group were delivered directly to the radiology department for x-ray examination. Patients were then transferred directly to the orthopaedic ward after radiographic confirmation of a hip fracture. (n=292, 195 completed follow-up; Mean age: 83; 63M/132F)
Comparison: Accident & emergency (A&E) group: Patients in this group were transported to the A&E where an A&E nurse gave the patient an ID-bracelet, a blood test, and an ECG. Afterwards, the patient was instructed to wait to be examined by an orthopaedic surgeon before moving to the radiology department for x-ray examination. Patients were moved back to the A&E after taking x-rays to wait for a treatment decision. (n=279, 205 completed follow-up; Mean age: 82; 70M/135F)
Outcomes: Outcomes of this study include time from hospital arrival to x-ray, time from x-ray to surgery, time from hospital arrival to surgery, hospital stay duration, postoperative complications, and mortality.
Methods: RCT; prospective study
Time: Follow-up periods were not reported.
What were the important findings?
What should I remember most?
How will this affect the care of my patients?
The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.