Chiann Ni Thiam1,2, Hui Min Khor1,3, Gordon Hwa Mang Pang1,2, Wan Chieh Lim1,2, Tharshne Shanmugam1, C Sankara Kumar Chandrasekaran1,4, Simmrat Singh1,4, Mohd Idzwan Bin Zakaria1,5, Terence Ong6,7. 1. University Malaya Medical Centre, Jln Profesor Diraja Ungku Aziz, 59100, Kuala Lumpur, Malaysia. 2. Department of General Medicine, Hospital Kuala Lumpur, Ministry of Health, Jalan Pahang, 50586, Kuala Lumpur, Malaysia. 3. Department of Medicine, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia. 4. Department of Orthopaedic Surgery, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia. 5. Academic Unit Trauma and Emergency, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia. 6. University Malaya Medical Centre, Jln Profesor Diraja Ungku Aziz, 59100, Kuala Lumpur, Malaysia. terenceong@doctors.org.uk. 7. Department of Medicine, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia. terenceong@doctors.org.uk.
Abstract
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.
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.
Authors: Christian Thomas Pollmann; Jan Harald Røtterud; Jan-Erik Gjertsen; Fredrik Andreas Dahl; Olav Lenvik; Asbjørn Årøen Journal: BMC Musculoskelet Disord Date: 2019-05-24 Impact factor: 2.362
Authors: Thomas Klestil; Christoph Röder; Christoph Stotter; Birgit Winkler; Stefan Nehrer; Martin Lutz; Irma Klerings; Gernot Wagner; Gerald Gartlehner; Barbara Nussbaumer-Streit Journal: Sci Rep Date: 2018-09-17 Impact factor: 4.379
Authors: Che Suraya Zin; Nor Ilyani Nazar; Norny Syafinaz Rahman; Nor Elina Alias; Wan Rohaidah Ahmad; Nurul Sahida Rani; Mary Suma Cardosa; Kim Swan Ng; Felicia Loh Ye Journal: J Pain Res Date: 2018-09-20 Impact factor: 3.133