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Patients with suspected hip fracture in the chain of emergency care: An integrative review of the literature
Örebro University, School of Health Sciences. Research and Development Centre, Skaraborg Hospital, Skövde, Sweden; Centre for Health Care Sciences, Örebro County Council, Örebro, Sweden.ORCID iD: 0000-0001-7690-1735
PreHospen - Centre for Prehospital Research, University of Borås, Borås, Sweden; Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden.
PreHospen - Centre for Prehospital Research, University of Borås, Borås, Sweden; Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden.
2018 (English)In: International Journal of Orthopaedic and Trauma Nursing, ISSN 1878-1241, E-ISSN 1878-1292, Vol. 29, p. 16-31Article, review/survey (Refereed) Published
Place, publisher, year, edition, pages
Elsevier, 2018. Vol. 29, p. 16-31
Keywords [en]
Hip fractures, Pain, Pain assessment, Pain management, Cognitive impairment, Emergency care
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Nursing
Identifiers
URN: urn:nbn:se:oru:diva-67032DOI: 10.1016/j.ijotn.2017.11.002ISI: 000432461300004PubMedID: 29631852Scopus ID: 2-s2.0-85046756618OAI: oai:DiVA.org:oru-67032DiVA, id: diva2:1207075
Available from: 2018-05-18 Created: 2018-05-18 Last updated: 2019-09-25Bibliographically approved
In thesis
1. Pain management in older persons with hip fractures
Open this publication in new window or tab >>Pain management in older persons with hip fractures
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to evaluate the preoperative management of pain from the perspectives of a literature overview, emergency medical service pain management, an intervention with a fascia iliaca compartment block and the association between cognitive status and the treatment of pain. Paper 1 is an integrative review of the literature on emergency care in patients with hip fractures or suspected hip fractures. Pain is a major problem for patients suffering a hip fracture when waiting for surgery and it is challenging for health care to provide sufficient pain relief. Listening to the patient’s narrative and the mandatory use of pain scales and pain documentation are necessary to deepen our understanding of individual patients’ needs. Paper 2 is a prospective observational study that explored the prehospital pain levels in 1,426 patients with suspected hip fractures. Furthermore, this study evaluated prehospital pain management. At the site of the injury, patients with hip fractures are often in substantial pain. Seventy-five per cent of the patients received pain relief from the emergency medical service (EMS) care providers and the pain relief was often effective. Several of the patients that did not receive prehospital pain relief had moderate to severe pain. Paper 3 is a randomised placebo-controlled double-blind trial (RCT) of 127 patients waiting for surgery. This RCT evaluated the effect of fascia iliaca compartment blocks (FICB) in relation to pain and medical pain relief, when added to regular preoperative analgesia. FICB improved pain relief when compared with regular analgesia alone (p=0.002). Paper 4 examined whether preoperative pain management with FICB could have an effect on cognitive status in the same 127 patients that were included in Paper 3. No impact on cognitive impairment was proven in this study. Patients with severe cognitive impairment received significantly lower doses of prehospital morphine than patients with higher cognitive status. Prehospital and hospital pain management need to improve. Pain management is especially challenging in persons with cognitive impairment.

Place, publisher, year, edition, pages
Örebro: Örebro University, 2019. p. 70
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 197
Keywords
Pain, Pain management, Hip fractures, Cognitive status, Nerve blocks, Emergency medical services
National Category
Other Health Sciences
Identifiers
urn:nbn:se:oru:diva-75191 (URN)978-91-7529-301-1 (ISBN)
Public defence
2019-10-18, Örebro universitet, Campus USÖ, hörsal C1, Södra Grev Rosengatan 32, Örebro, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2019-07-22 Created: 2019-07-22 Last updated: 2019-09-25Bibliographically approved

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Wennberg, Pär

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