Out-of-Hospital Neck of Femur Injury: An Eight-Year Observational Analysis.

Abstract

Objectives: Pain management for patients with neck of femur fractures is a challenge for out-of-hospital clinicians. This study aimed to describe (1) the characteristics of patients presenting to emergency medical services (EMS) with suspected neck of femur injuries, (2) clinically meaningful pain reduction, and (3) ongoing moderate to severe pain in the out-of-hospital setting.

Methods: A retrospective cohort study of adult patients with suspected neck of femur injuries attended by EMS in Victoria, Australia, between 01 July 2015 and 30 June 2023. Multivariable logistic regression was used to examine factors associated with clinically meaningful pain reduction and moderate to severe pain upon final EMS assessment.

Results: In total, 15,937 patients were included. The median age was 84 (Interquartile Range 76-89) years, 70% were female, and 92% occurred because of a fall. Clinically meaningful pain reduction was achieved for 13,136 (82%) patients, however, 4,859 (30.5%) patients reported moderate to severe final pain. According to adjusted analysis, increasing age (Adjusted Odds Ratio (AOR) = 1.026, 95% Confidence Interval (CI): 1.021, 1.031), paramedic attendance (relative to basic life support-trained personnel, AOR = 3.471 (95%CI 2.921, 4.125)), increasing initial pain score (AOR = 1.705 (95%CI 1.665, 1.747)), application of a splint (AOR = 1.272 (95%CI 1.147, 1.411)) and analgesia administration including opioids and methoxyflurane were associated with clinically meaningful pain reduction. Factors associated with reduced odds of moderate to severe final pain included paramedic attendance (AOR = 0.298 (95%CI 0.251, 0.354)) and splint application (AOR = 0.788 (95%CI 0.730, 0.850)).

Conclusions: Although most patients with neck of femur fractures reported a clinically meaningful reduction in pain, 30.5% of patients reported moderate to severe pain upon conclusion of out-of-hospital treatment. Expansion of analgesic options available to basic life support-trained patient transport officers and educating prehospital clinicians on the safety and efficacy of analgesics and splinting practices represent future opportunities for improvement.