A case-control study examining inconsistencies in pain management following fractured neck of femur: an inferior analgesia for the cognitively impaired

Hip fractures represent a significant workload of both emergency and orthopaedic departments within the National Health Service (NHS). Pain relief is key in treating hip fractures as highlighted by both National Institute of Clinical Excellence (NICE) and British Orthopaedic Association Standards for Trauma (BOAST) guidelines. However, the literature shows that patients with cognitive impairment tend to have inconsistent pain management, leading to worse outcomes. We conducted a case–control study looking at 296 patients who presented with hip fractures to a major trauma centre between 1 December 2019 and 30 May 2020. Cognition was assessed using pre-recorded Abbreviated Mental Test Scores (AMTS). There was no significant difference between pain relief provided to patients with or without cognitive impairment in both the pre-hospital (p = 0.208) and Accident & Emergency (A&E) (p = 0.154) setting. A larger proportion of patients in A&E did not receive any pain relief (18.6% versus 42.2%). Pre-hospital, the higher the pain score, the stronger the analgesia given (R = 0.435, p = 0.000). This relationship was present in both the cognitively impaired (R = 0.572, p = 0.000) and cognitively intact groups (R = 0.390 p = 0.000). Strength of analgesia and pain scores did not correlate in A&E (R = 0.014, p = 0.826). Cognition did not impact the time to analgesia both pre-hospital (p = 0.291) and in A&E (p = 0.332); however, patients waited significantly longer to receive pain relief in A&E (29.61 minutes versus 150.28 minutes). Fascia-iliaca blocks were administered to 58.4% of the cohort, with no significant difference noted between cognition status. Overall, cognition does not impact pain management both pre-hospital and in A&E. There is still room for improvement, particularly in the assessment of pain in the cognitively impaired. A possible solution is the utilisation of the Bolton Pain Assessment Tool, a validated pain assessment tool for the cognitively impaired that has been utilised in the trauma setting with good effect.

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816 The Effect Of COVID-19 And Service Delivery Changes On 30-Day Mortality in Fractured Neck of Femur Patients: A Case-Control Study

British Journal of Surgery ◽

10.1093/bjs/znab134.089 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

A Winarski ◽

L Williams ◽

H Ingoe

Keyword(s):

Logistic Regression ◽

Service Delivery ◽

Case Control Study ◽

Statistical Significance ◽

Binary Logistic Regression ◽

Case Control ◽

Median Length ◽

Fractured Neck Of Femur ◽

Neck Of Femur ◽

Control Study

Abstract Introduction The majority of neck of femur (NOF) fractures occur within the home, therefore admissions were not expected to change during the COVID-19 pandemic(1) . This study investigates the effect of coronavirus and our department’s response on 30-day mortality for patients admitted with NOF fractures. Method Data from 65 fractured NOF admissions (22nd March - 24th May 2020) was compared with 62 patients from the same period in 2019. Binary logistic regression was used to explore 30-day mortality; accounting for differences in ASA, anaesthetic type, anticoagulation status, surgery type, age, time to surgery and year of admission. Results The odds of 30-day mortality was statistically significantly higher in patients who were suspected/confirmed COVID-19 positive (n = 10),(OR 2.39, 95%CI (1.60-74.13)). In COVID-19 negative patients (n = 55), the odds of 30-day mortality was lower in 2020, and approached statistical significance (0.232, 95%CI (0.053-1.02)), compared to the same period in 2019. Median length of stay (LOS) in patients who survived was 11 days in 2020 and 15.5 days in 2019 (p = 0.003). Conclusions The results suggest that a COVID-19 diagnosis significantly increases the 30-day mortality in patients with a fractured NOF. The changes implemented in service delivery have shortened LOS and appeared to improve 30-day mortality for those without COVID-19.

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Pain Management After Total Knee Arthroplasty: A Case-Control Study of Continuous Femoral Nerve Block Therapy

Journal of PeriAnesthesia Nursing ◽

10.1016/j.jopan.2013.04.143 ◽

2013 ◽

Vol 28 (3) ◽

pp. e50

Author(s):

Karenirene Thomas ◽

Barbara Barrett ◽

Ruth Tupper ◽

Lydia Dacenko-Grawe ◽

Karyn Holm

Keyword(s):

Total Knee Arthroplasty ◽

Pain Management ◽

Knee Arthroplasty ◽

Case Control Study ◽

Femoral Nerve Block ◽

Femoral Nerve ◽

Case Control ◽

Continuous Femoral Nerve Block ◽

Total Knee ◽

Control Study

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Palliative Management of Nonoperative Femoral Neck Fractures With Continuous Peripheral Indwelling Catheters: Case–Control Series

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/2151459319827470 ◽

2019 ◽

Vol 10 ◽

pp. 215145931982747 ◽

Cited By ~ 1

Author(s):

Christopher H. Rashidifard ◽

Nicholas Romeo ◽

Mark Richardson ◽

Paul Muccino ◽

Thomas DiPasquale ◽

...

Keyword(s):

Pain Management ◽

Femoral Neck ◽

Case Control Study ◽

Case Control ◽

Femoral Neck Fractures ◽

Control Groups ◽

Ambulatory Status ◽

Pain Scores ◽

And Control ◽

Control Study

Introduction: This case–control study evaluates the success of indwelling pain catheters in nonoperatively treated femoral neck fractures (FNFs) for end-of-life pain management. Methods: Patients older than 65 years with nonoperatively treated FNFs were retrospectively identified at a level 1 trauma center between March 2012 and September 2015. Twenty-three received indwelling continuous peripheral pain catheters (experimental) and 10 received traditional pain control modalities (control). Pain scores 24 hours before/after pain management interventions, ambulation status at admission and discharge, mortality at 30 days/1 year, and length of hospital stay (LOS) were compared between treatment groups. Results: The experimental and control groups were similar with respect to demographics, differing only in pre-fracture ambulatory status ( P = .03). The 30-day mortality was 52% versus 50% (odds ratio, OR: 1.1 [95% confidence interval, CI: 0.25-4.82], P = .99) and 1-year mortality was 87% versus 80% (OR: 1.67 [95% CI: 0.23-11.9], P = .63) for experimental and control groups, respectively. The LOS did not statistically significantly differ for experimental and control groups (5.3 ± 3.56 days vs 3.8 ± 1.81 days, P = .15), respectively. The experimental group experienced twice the improvement in ambulation status (1.0 ± 0.56 vs 0.5 ± 0.71, P = 0.03) and greater improvement in pain scores (4.5 ± 2.19 vs 1.2 ± 2.72, P = .002). Discussion: Operative management of FNFs may not be indicated in patients with advanced age and comorbidities. Regardless, these patients require pain palliation and early mobilization while minimizing hospital LOS and opiate consumption. Conclusion: This case–control study demonstrates significant improvement in both pain level and ambulatory status for patients treated with indwelling continuous peripheral catheters. Future studies should further evaluate with a larger sample size; however, this study provides an excellent launching point for palliative management of this complex population.

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