An intervention to train emergency department physicians in point-of-care ultrasound-guided regional anesthesia may reduce risk of delirium in patients with hip fractures

1. An intervention to increase point-of-care ultrasound-guided regional anesthesia (POCUS-GRA) uptake by emergency physicians was safe, effective, and significantly reduced the odds of delirium.

Evidence Rating Level: 1 (Excellent)

Delirium complicates 20-62% of hip fractures, prolonging hospital stay and increasing mortality. Previous studies have shown that regional anesthesia provides better pain management than parenteral opioid analgesics in hip fractures, and is associated with reduced delirium risk. This study sought to train emergency department (ED) physicians in POCUS-GRA and assess whether this intervention reduces the incidence and duration of delirium in patients with hip fractures. This randomized, stepped-wedge cluster design study randomized the order of ED physician training. Patients treated by an ED physician prior to training were assigned to the control group; patients treated after training were assigned to the intervention group. 732 patients were randomly allocated to the intervention (n = 446; median [IQR] age, 81.0 (73.0-88.0) years; 32.7% male) and control (n = 248; median [IQR] age, 82.0 (75.0-88.0) years; 26.2% male) groups. Once trained, ED physicians completed nerve blocks on 236 participants (52.9%) in the intervention group (compared with 6 of 24 participants before the intervention [2.2%], a 51.7% improvement). The failure rate among trained treating physicians was 1 of 237 attempts (0.4%) vs 3 of 9 attempts (33.3%) among untrained treating physicians. No serious complications and one minor complication occurred. Patients in the intervention group had significantly lower odds of delirium compared to those in the control group (odds ratio, 0.72; 95% CI, 0.57-0.93). There was no significant reduction in the duration of delirium (incident rate ratio, 0.92; 95% CI, 0.67-1.25). Overall, POCUS-GRA training was safe and effectively increased nerve block uptake in the ED. These results also suggest POCUS-GRA is effective at reducing delirium risk. Future studies are required to further establish this finding and identify strategies to improve POCUS-GRA uptake.

Click here to read this study in JAMA Network Open

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