Delirium Clinical Trial
Official title:
ED Ultrasonographic Regional Anesthesia to Prevent Incident Delirium in Hip Fracture Patients (EDU-RAPID) Multi-center Stepped Wedge Cluster Randomized Trial
Hip fractures are common, costly and affect older people - Canadians spend 1 billion dollars
to treat hip fractures each year. Unfortunately, as many as two-thirds of hip fracture cases
suffer a complication known as delirium, or acute confusion. Patients with delirium may
become frightened and agitated. This in turn leads to other serious problems. Having
delirium doubles the chances of dying or can increase the need for admission into a nursing
home. People with delirium spend an extra week in hospital on average.
Using ultrasound to locate and 'freeze' or block specific nerves can stop hip fracture pain
almost immediately, and use of this technique is known to reduce delirium when administered
by Anaesthetists to patients at the time of their hip operation. Unfortunately, patients
with hip fractures commonly wait hours or even days in the Emergency Department (ED) prior
to their operation. Currently, these patients are given narcotic pain killers like morphine
to dull their pain, as most ED physicians have not been trained in using this 'freezing'
technique and Anaesthetists are rarely able to leave the operating room to administer
freezing to patient in the ED.
The EDU-RAPID study will test whether training ED physicians on how to use the nerve
freezing technique will reduce the number of patients who develop delirium after a hip
fracture. To study this, ED physicians will be trained at 6 hospitals in small groups every
6 weeks over 18 months. The study will look at how patients who are treated by ED physician
who has been trained compare to patients treated by a ED physician who has not yet been
trained. Also, the study will see if the training motivates ED physicians to use the block
regularly.
If correct, this study could significantly improve the comfort, quality of life, and
independence of patients who suffer a hip fracture. In addition, if the study shows a
reduction in delirium rates, this could represent a significant cost reduction to the health
care system.
n/a
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Crossover Assignment, Masking: Single Blind (Outcomes Assessor), Primary Purpose: Prevention
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