Lowell W Gerson1, Jennifer A Emond, Carlos A Camargo. 1. Department of Community Health Sciences, Northeastern Ohio Universities College of Medicine, Rootstown, OH 44272, USA. lgerson@neoucom.edu
Abstract
BACKGROUND: Hip fracture is a significant injury for older persons. Little has been reported about emergency department (ED) care of these patients. OBJECTIVE: To characterize the management of older patients treated in the ED for hip fracture with specific attention to the use of analgesia. METHODS: This study analysed data from the National Hospital Ambulatory Medical Care Survey ( approximately 400 hospitals report each year) for the years 1992-2000. We included records of patients who were at least 50 years old and had a diagnosis of hip fracture (International Classification of Disease, 9th revision, clinical modification 820-820.9) in any of the three fields allowed for recording diagnosis. RESULTS: There were 1,935,000 ED visits ( approximately 215,000 a year), predominantly among older white women. The rate in those over 80 years old was 25 times that of the youngest group. Fifty-six per cent of patients received analgesia (44% narcotics). There were no ethnic or racial distinctions in the use of analgesia. CONCLUSIONS: The ED visit presents a largely untapped opportunity for focused efforts in fall and hip fracture prevention, especially in countries with comprehensive geriatric services and well integrated healthcare delivery systems. Despite the high likelihood of pain, the administration of analgesics appears to be low and may be a worthy focus for practice improvement.
BACKGROUND:Hip fracture is a significant injury for older persons. Little has been reported about emergency department (ED) care of these patients. OBJECTIVE: To characterize the management of older patients treated in the ED for hip fracture with specific attention to the use of analgesia. METHODS: This study analysed data from the National Hospital Ambulatory Medical Care Survey ( approximately 400 hospitals report each year) for the years 1992-2000. We included records of patients who were at least 50 years old and had a diagnosis of hip fracture (International Classification of Disease, 9th revision, clinical modification 820-820.9) in any of the three fields allowed for recording diagnosis. RESULTS: There were 1,935,000 ED visits ( approximately 215,000 a year), predominantly among older white women. The rate in those over 80 years old was 25 times that of the youngest group. Fifty-six per cent of patients received analgesia (44% narcotics). There were no ethnic or racial distinctions in the use of analgesia. CONCLUSIONS: The ED visit presents a largely untapped opportunity for focused efforts in fall and hip fracture prevention, especially in countries with comprehensive geriatric services and well integrated healthcare delivery systems. Despite the high likelihood of pain, the administration of analgesics appears to be low and may be a worthy focus for practice improvement.