Patients with hip fracture, in the prehospital environment Musculoskeletal Diseases Patients with hip fracture, in the prehospital environment
Conditions
Interventions
Participants are randomly allocated to one of two groups.
1. Group 1: Patients receive standard treatment and given normal pain relief (usually morphine)
2. Group 2: P
Sponsors
Welsh Ambulance Services NHS Trust
Eligibility
Sex/Gender
All
Inclusion criteria
Inclusion criteria: 1. Aged 18 years or over 2. Patients who are assessed by a paramedic as having a hip fracture (paramedics will make this assessment by using a hip fracture diagnosis checklist tool)
Exclusion criteria
Exclusion criteria: 1. Patient refuses to participate 2. Patient is combative 3. Patient has an allergy to local anaesthetic 4. Patient is receiving coagulopathy (use of warfarin, clopidogrel or ‘new’ anticoagulants) 5. Patient has any other distracting injury (i.e. has pain in a different place, which would make taking pain scores for only the hip difficult) 6. Patient has decreased level of consciousness (Glasgow Coma Scale score of less than 14) 7. Patient is haemodynamically unstable 8. Patient has neurovascular damage to the affected leg 9. Patient has received previous femoral bypass surgery 10. Patient has an infection at the site of insertion of the injection 11. The paramedic is unable to palpate the femoral artery on the affected leg 12. Patients who appear to have body mass of less than 50kg (A 50kg patient could safely be given 6ml/kg of 1% prilocaine. By only using 30ml of the local anaesthetic, we will have a margin of safety to avoid patients developing local anaesthetic toxicity).
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Our feasibility study objectives are as follows: to assess 1. Accuracy, in particular specificity, of recognition of hip fracture by paramedics in order to establish appropriate and safe delivery of the intervention. 2. Willingness of both patients and paramedics to participate in the study. 3. Compliance with the intervention by paramedics. 4. Sample size required for a full RCT, and recruitment period required to achieve target. 5. Acceptability of the method of providing pain relief in the prehospital care of patients with hip fracture. 6. Which outcome measures should be used in a full RCT and at what point they should be recorded. Proposed outcomes measures to be tested are: 6.1. Self-reported pain level using numeric rating scale of 0- 10 with 0 being no pain at all and 10 being the worst pain imaginable. This will be recorded immediately before pain relief is given and repeated on arrival at the hospital by the triage nurse (before they know which pain relief the patient received). 6.2. Patient satisfaction with the care they received from paramedics using a modified Quality of Care Monitor. This will be measured when the NHS researcher takes consent to participate in the trial at approximately 7-10 days after the patient's injury 6.3. Complications of FICB (Patient safety – adverse events (AE) and serious adverse events (SAE) will be recorded) 6.4. Length of time that the paramedics were with the patient (in order to determine whether providing FICB has a significant effect of delaying the paramedics) 6.5. Requirement of antiemetics and alternative analgesia 6.6. Length of stay 6.7. Mortality at 30 days and/or at six months 6.8. Time from admission to surgery 6.9. Health related quality of life, using SF12 at 30 days and/o | — |
Secondary
| Measure | Time frame |
|---|---|
| No secondary outcome measures | — |
Countries
United Kingdom, Wales
Contacts
Public ContactJenna Bulger
Outcome results
None listed