Professional paper

PREHOSPITAL PAIN MANAGEMENT IN PATIENTS WITH HIP FRACTURE

ANĐELA SIMIĆ ; Institute of Emergency Medicine of Varaždin County, Varaždin, Croatia
VIŠNJA NESEK ADAM ; Sveti Duh University Hospital, Department of Emergency Medicine, Zagreb, Sveti Duh University Hospital, Department of Anesthesiology, Resuscitation and Intensive Care, Zagreb, Josip Juraj Strossmayer University in Osijek, Faculty of Medicine, Osijek, Croa
IVAN JURIĆ ; Sveti Duh University Hospital, Department of Emergency Medicine, Zagreb, Croatia
RENATO ŠTIMAC ; Institute of Emergency Medicine of Varaždin County, Varaždin, Croatia
LUCIJA STOJČIĆ ; Teaching Institute of Emergency Medicine of City of Zagreb, Zagreb
FRAN RAŠIĆ ; University of Zagreb, School of Medicine, Zagreb, Croatia
ŽARKO RAŠIĆ ; Sveti Duh University Hospital, Department of Surgery, Zagreb, Croatia

Abstract

Objective: Hip fracture is a signifi cant public health and personal issue, especially for elderly patients, where it is the second most common diagnosis in stationary hospitalization in Croatia. Although numerous research studies have revealed the importance of early assessment and pain management during emergency care of such patients, it is still not applied systematically, and literature data on the use of analgesics and immobilization during transport are limited. The objective of this study was to research prehospital pain management in patients with hip fracture, primarily the frequency of prehospital analgesic administration. Methods: We conducted a cross-sectional analytical study of patients with clinically diagnosed hip fractures at the Institute of Emergency Medicine of Varaždin County during a one-year period (from January 1, 2018 to December 31, 2018). Results: In 2018, a total of 187 patients with hip fracture were treated, 133 (71.1%) women, mean age 80.8±8.3 (median 79, mod 84) years. Level of pain was assessed in 92% of patients; strong pain (NRS 7-10) was present in 19.8%, medium pain (NRS 4-6) in 57%, mild pain (NRS 1-3) in 19.8% and no pain (NRS 0) in 3.5% of patients. Analgesics were not administered in 90.4% of all cases, specifi cally in 67.6% of the strong pain group. In the rest of cases, the most frequently applied analgesic was tramadol. Application of analgesics was somewhat more frequent in male patients but the difference was not statistically signifi cant. Immobilization during transport was not applied in 56.1% of cases, whereas in the remainder it was mostly done by use of scoop stretcher or vacuum mattress. Discussion: This study showed insuffi cient use of analgesics in spite of general recognition of the importance of pain treatment. The most frequently applied analgesic was tramadol, which is no longer recommended as a fi rst choice medication. There are limited research data on prehospital pain management in this group of patients, but also point out the inadequate use of analgesics in patients with hip fracture, as well in other trauma patients. Various factors infl uence the frequency and method of analgesic application and one of these is certainly emergency medical service staff education, which has a well-established benefi cial effect on the emergency patient care. Limitations of this study were retrospective data collection and the high likelihood that some of the patients were transported by ordinary patient transport service upon initial physician assessment. Therefore, the number of cases presented does not cover the total of all hip fracture cases in the Varaždin County in 2018. Conclusion: The great majority of patients with hip fracture did not receive analgesics during prehospital emergency care and in more than half of all cases there was no immobilization during transport. Although there was a tendency of more frequent application of analgesics in male patients, the difference was not statistically signifi cant. As the condition is mostly affecting elderly patients, it is very important to improve prehospital pain management during their emergency care, which could be achieved by better education of emergency medical service team members.

Keywords

pain management; hip fracture; emergency medical services

Hrčak ID:

236585

URI

https://hrcak.srce.hr/236585

Publication date:

16.3.2020.

Article data in other languages: croatian

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