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Out-of-Hospital Neck of Femur Injury: An Eight-Year Observational Analysis.
Richard Hartley1,2, Ziad Nehme1,3,4, Brendan Schultz2,5
1Department of Paramedicine, Monash University, Melbourne, Australia.
Prehospital Emergency Care
|May 5, 2025
Summary
Effective pain management for neck of femur fractures remains a challenge. While most patients experienced pain reduction, 30.5% still had moderate to severe pain post-treatment.
Area of Science:
- Emergency Medicine
- Traumatology
- Pain Management
Background:
- Neck of femur fractures present significant pain management challenges in prehospital settings.
- Effective out-of-hospital pain relief is crucial for patient outcomes.
Purpose of the Study:
- To characterize patients with suspected neck of femur injuries presenting to emergency medical services (EMS).
- To assess clinically meaningful pain reduction in the out-of-hospital setting.
- To identify factors associated with ongoing moderate to severe pain.
Main Methods:
- Retrospective cohort study of adult patients with suspected neck of femur fractures attended by EMS in Victoria, Australia (2015-2023).
- Multivariable logistic regression analysis was employed to identify associated factors.
Main Results:
- 82% of 15,937 patients achieved clinically meaningful pain reduction.
- However, 30.5% reported moderate to severe final pain.
- Factors associated with pain reduction included advanced age, paramedic attendance, higher initial pain, splinting, and analgesia administration.
Conclusions:
- Despite overall pain reduction, a significant proportion of patients experience persistent moderate to severe pain.
- Opportunities for improvement include expanding analgesic options for basic life support personnel and enhancing clinician education on pain management strategies.
