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An evaluation of emergency pain management practices in fragility fractures of the pelvis

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Canadian Journal of Emergency Medicine Aims and scope Submit manuscript

Abstract

Background

Inadequately treated pain is associated with significant morbidity in older adults. We aimed to describe current pain management practices for patients with fragility pelvic fractures, a common emergency department (ED) presentation in older adults.

Methods

We performed a health records’ review of adults ≥ 65 years old who presented to two academic EDs with nonoperative fragility pelvic fractures between 01/2014 and 09/2018. The primary outcome measures were type and timing of analgesic medications. Secondary outcome measures included ancillary service consultation, ED length of stay, admission rate and rate of return to ED at 30 days. Data were reported using descriptive statistics.

Results

We included 411 patients. The majority were female (339, 82.5%) with mean age 83.9 (SD 8.1) years. Nearly, one-third (130, 31.6%) did not receive any analgesia for their fracture. Analgesia was initiated in 123 (29.9%) patients through paramedic and nursing medical directives; 244 (59.4%) patients received physician-initiated opioids (hydromorphone 228 (55.5%); morphine 28 (6.8%)). Only 23.1% of patients received one or more ancillary services: physiotherapy (10.5%), social work (7.3%), geriatric nurse assessment (14.1%), and homecare (3.9%). Mean ED length of stay was 11.6 (SD 7.1) h; 210 (51.1%) patients were admitted; of those discharged, 45 (22.4%) returned to the ED within 30 days.

Conclusion

One in three older adults presenting to the ED with nonoperative fragility pelvic fractures receive no analgesia during the course of their prehospital and ED care. Barriers to quality care must be identified and processes implemented to ensure adequate pain management for this population.

Résumé

Contexte

La douleur insuffisamment traitée est associée à une morbidité importante chez les personnes âgées. Nous voulions décrire les pratiques actuelles de gestion de la douleur chez les patients souffrant de fractures pelviennes de fragilité, une présentation courante des services d’urgence (SU) chez les personnes âgées.

Méthodes

Nous avons effectué une revue des dossiers médicaux des adultes ≥ 65 ans qui se sont présentés à deux urgences universitaires avec des fractures pelviennes de fragilité non opérées entre 01/2014 et 09/2018. Les principaux critères d'évaluation étaient le type et le moment de la prise de médicaments analgésiques. Les critères d'évaluation secondaires comprennent la consultation des services auxiliaires, la durée moyenne de séjour aux urgences, le taux d'admission et le taux de retour aux urgences à 30 jours. Les données ont été rapportées en utilisant des statistiques descriptives.

Résultats

Nous avons inclus 411 patients. La majorité était des femmes (339, 82,5%) avec un âge moyen de 83,9 (écart-type 8,1) ans. Près d'un tiers (130, 31,6 %) n'ont reçu aucune analgésie pour leur fracture. L'analgésie a été initiée chez 123 (29,9%) patients par des directives médicales paramédicales et infirmières ; 244 (59,4%) patients ont reçu des opioïdes à l'initiative du médecin (hydromorphone 228 (55,5%) ; morphine 28 (6,8%)). Seuls 23,1% des patients ont bénéficié d'un ou plusieurs services auxiliaires : physiothérapie (10,5%), travail social (7,3%), évaluation infirmière gériatrique (14,1%) et soins à domicile (3,9%). La durée moyenne de séjour aux urgences était de 11,6 heures (écart-type : 7,1); 210 (51,1 %) patients ont été admis ; parmi ceux qui sont sortis, 45 (22,4 %) sont retournés aux urgences dans les 30 jours.

Conclusion

Une personne âgée sur trois se présentant aux urgences avec des fractures du bassin non opératoires ne reçoit aucune analgésie au cours de ses soins préhospitaliers et aux urgences. Les obstacles à la qualité des soins doivent être identifiés et des processus doivent être mis en œuvre pour assurer une gestion adéquate de la douleur pour cette population.

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Acknowledgements

We thank Ms. Angela Marcantonio for her assistance with this project.

Funding

There are no funding sources.

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Authors and Affiliations

  1. Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada

    Uyen Evelyn Tran, Krishan Yadav, Michael Austin & Debra Eagles

  2. Western University, London, ON, Canada

    Mohamed Mohamed Ali

  3. Clinical Epidemiology Program, Ottawa Hospital Research Institute, F658a, Civic Campus, 1053 Carling Ave, Ottawa, ON, K1Y 4E9, Canada

    Krishan Yadav, Michael Austin, Marie-Joe Nemnom & Debra Eagles

  4. School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada

    Debra Eagles

  5. Regional Paramedic Program for Eastern Ontario, Ottawa, ON, Canada

    Michael Austin

Authors
  1. Uyen Evelyn Tran
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  2. Krishan Yadav
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  3. Mohamed Mohamed Ali
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  4. Michael Austin
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  5. Marie-Joe Nemnom
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  6. Debra Eagles
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Contributions

ET was responsible for study development, data collection, monitoring of data abstraction, and writing of the manuscript. MMA assisted with data abstraction and contributed to the methods section of the manuscript. MJN provided valuable input on data analysis and contributed to the analysis section of the manuscript. DE, MA and KY were involved with study design and development. All the authors provided substantive feedback on the manuscript.

Corresponding author

Correspondence to Debra Eagles.

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The authors have no conflicts of interest to declare.

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Tran, U.E., Yadav, K., Ali, M.M. et al. An evaluation of emergency pain management practices in fragility fractures of the pelvis. Can J Emerg Med 24, 273–277 (2022). https://doi.org/10.1007/s43678-022-00265-5

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  • DOI: https://doi.org/10.1007/s43678-022-00265-5

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