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Hip fracture management in the emergency department and its impact on hospital outcomes: a retrospective cross-sectional analysis

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Key summary points

AbstractSection Aim

This study aims to report on the time taken to deliver crucial treatment for patients with hip fracture in the Emergency Department (ED) of a tertiary centre and identify any association between time spent in ED and hospital health outcomes.

AbstractSection Findings

Hospital hip fracture care in this ED was delivered in a timely manner. Spending ≥ 5 h in ED before transfer to the orthopaedic ward was associated with cardiac events and prolonged (≥ 14 days) hospital stay, but not mean length of stay, discharge to care home, or in-hospital death.

AbstractSection Message

Hospital hip fracture care starts upon arrival to the ED and there are points for improvement according to international guidelines on analgetic methods and the use of specified care protocols.

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.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Acknowledgements

We are thankful for the administrative support provided by the health records department and the Department of Orthopaedic Surgery. This study was supported by a University of Malaya Bantuan Kecil Penyelidikan (BK022-2016) research grant.

Funding

This project was funded by the University of Malaya Bantuan Kecil Penyelidikan (BKP) research grant.

Author information

Authors and Affiliations

  1. University Malaya Medical Centre, Jln Profesor Diraja Ungku Aziz, 59100, Kuala Lumpur, Malaysia

    Chiann Ni Thiam, Hui Min Khor, Gordon Hwa Mang Pang, Wan Chieh Lim, Tharshne Shanmugam, C. Sankara Kumar Chandrasekaran, Simmrat Singh, Mohd Idzwan Bin Zakaria & Terence Ong

  2. Department of General Medicine, Hospital Kuala Lumpur, Ministry of Health, Jalan Pahang, 50586, Kuala Lumpur, Malaysia

    Chiann Ni Thiam, Gordon Hwa Mang Pang & Wan Chieh Lim

  3. Department of Medicine, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia

    Hui Min Khor & Terence Ong

  4. Department of Orthopaedic Surgery, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia

    C. Sankara Kumar Chandrasekaran & Simmrat Singh

  5. Academic Unit Trauma and Emergency, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia

    Mohd Idzwan Bin Zakaria

Authors
  1. Chiann Ni Thiam
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  2. Hui Min Khor
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  8. Mohd Idzwan Bin Zakaria
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  9. Terence Ong
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Contributions

TO, HMK, CSKC, SS and MIZ contributed to the study conception and design. Material preparation, data collection and analysis were performed by CNT, GHMP and WCL. The first draft of the manuscript was written by CNT, GHMP and TO. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Terence Ong.

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Conflict of interest

The authors (CNT, HMK, GHMP, WCL, TS, CSKC, SS, MIZ, TO) declare that they have no relevant financial or non-financial interests to disclose related to this study.

Ethical approval

Ethical approval was obtained from the University of Malaya Research Ethics Committee (reference number 20163-2260).

Consent to participate

No individual participant consent was required. Ethical approval was granted to analyse routinely held hospital electronic records.

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We consent for this manuscript to be published by this journal upon acceptance after the peer review and editing process.

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Thiam, C.N., Khor, H.M., Pang, G.H.M. et al. Hip fracture management in the emergency department and its impact on hospital outcomes: a retrospective cross-sectional analysis. Eur Geriatr Med 13, 1081–1088 (2022). https://doi.org/10.1007/s41999-022-00654-0

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  • DOI: https://doi.org/10.1007/s41999-022-00654-0

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