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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Accelerated care versus standard care among patients with hip fracture: The HIP ATTACK pilot trial
CMAJ. Canadian Medical Association Journal, Volume 186, No. 1, Year 2014
Notification
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Description
Background: A hip fracture causes bleeding, pain and immobility, and initiates inflammatory, hypercoagulable, catabolic and stress states. Accelerated surgery may improve outcomes by reducing the duration of these states and immobility. We undertook a pilot trial to determine the feasibility of a trial comparing accelerated care (i.e., rapid medical clearance and surgery) and standard care among patients with a hip fracture. Methods: Patients aged 45 years or older who, during weekday, daytime working hours, received a diagnosis of a hip fracture requiring surgery were randomly assigned to receive accelerated or standard care. Our feasibility outcomes included the proportion of eligible patients randomly assigned, completeness of follow-up and timelines of accelerated surgery. The main clinical outcome, assessed by data collectors and adjudicators who were unaware of study group allocations, was a major perioperative complication (i.e., a composite of death, preoperative myocardial infarction, myocardial injury after noncardiac surgery, pulmonary embolism, pneumonia, stroke, and life-threatening or major bleeding) within 30 days of randomization. Results: Of patients eligible for inclusion, 80% consented and were randomly assigned to groups (30 to accelerated care and 30 to standard care) at 2 centres in Canada and 1 centre in India. All patients completed 30-day follow-up. The median time from diagnosis to surgery was 6.0 hours in the accelerated care group and 24.2 hours in the standard care group (p 0.001). A major perioperative complication occurred in 9 (30%) of the patients in the accelerated care group and 14 (47%) of the patients in the standard care group (hazard ratio 0.60, 95% confidence interval 0.261.39). Interpretation: These results show the feasibility of a trial comparing accelerated and standard care among patients with hip fracture and support a definitive trial. Trial registration: ClinicalTrials.gov, no. NCT01344343. © 2014 Canadian Medical Association or its licensors.
Available Materials
https://efashare.b-cdn.net/share/pmc/articles/PMC3883849/bin/supp_186_1_E52__index.html
https://efashare.b-cdn.net/share/pmc/articles/PMC3883849/bin/supp_130901_fracture-devereaux-1-at.pdf
https://efashare.b-cdn.net/share/pmc/articles/PMC3883849/bin/supp_130901_fracture-devereaux-2-at.pdf
https://efashare.b-cdn.net/share/pmc/articles/PMC3883849/bin/supp_130901_fracture-devereaux-3-at.pdf
Authors & Co-Authors
Lurati Buse, Giovanna A.L.
Switzerland, Basel
Universitätsspital Basel
Bhandari, Mohit
Canada, Hamilton
Mcmaster University
Sancheti, Parag Kantilal
India, Pune
Sancheti Institute for Orthopaedics and Rehabilitation
Rocha, Steve
India, Pune
Sancheti Institute for Orthopaedics and Rehabilitation
Winemaker, Mitchell Jeffrey
Canada, Hamilton
Mcmaster University
Adili, Anthony F.
Canada, Hamilton
Mcmaster University
de Beer, Justin V.
Canada, Hamilton
Mcmaster University
Tiboni, Maria E.
Canada, Hamilton
Mcmaster University
Neary, John D.D.
Canada, Hamilton
Mcmaster University
Dunlop, Valerie
Canada, Hamilton
Population Health Research Institute, Ontario
Gauthier, Leslie P.
Canada, Hamilton
Hamilton Health Sciences
Patel, Ameen
Canada, Hamilton
Mcmaster University
Robinson, Andrea
Canada, Hamilton
Population Health Research Institute, Ontario
Canada, Hamilton
Mcmaster University
Rodseth, Reitze Nils
Canada, Hamilton
Population Health Research Institute, Ontario
United States, Cleveland
Cleveland Clinic Foundation
South Africa, Durban
University of Kwazulu-natal
Kolesar, Rick
Canada, Hamilton
Mcmaster University
Farrell, Janet C.
Canada, Hamilton
Mcmaster University
Canada, Hamilton
St. Joseph's Healthcare Hamilton
Crowther, Mark Andrew
Canada, Hamilton
Mcmaster University
Tandon, Vikas
Canada, Hamilton
Mcmaster University
Magloire, Patrick
Canada, Hamilton
Mcmaster University
Dokainish, Hisham
Canada, Hamilton
Mcmaster University
Joseph, Philip G.
Canada, Hamilton
Mcmaster University
Tomlinson, Charles W.
Canada, Hamilton
Mcmaster University
Salehian, Omid
Canada, Hamilton
Mcmaster University
Hastings, Debbie
Canada, Hamilton
Mcmaster University
Hunt, Dereck L.
Canada, Hamilton
Mcmaster University
van Spall, Harriette Gillian Christine
Canada, Hamilton
Population Health Research Institute, Ontario
Canada, Hamilton
Mcmaster University
Cosman, Tammy L.
Canada, Hamilton
Hamilton Health Sciences
Simpson, Diane L.
Canada, Hamilton
Mcmaster University
Cowan, David D.
Canada, Hamilton
Mcmaster University
Gordon, Guyatt H.
Canada, Hamilton
Mcmaster University
Alvarado, Kim A.
Canada, Hamilton
Hamilton Health Sciences
Evans, W. K.
Canada, Hamilton
Hamilton Health Sciences
Canada, Hamilton
Mcmaster University
Mizera, Ryszard
Canada, Hamilton
Mcmaster University
Eikelboom, John W.
Canada, Hamilton
Mcmaster University
Cook, Deborah J.
Canada, Hamilton
Mcmaster University
Loeb, Mark B.
Canada, Hamilton
Mcmaster University
Canada, Hamilton
Mcmaster University, Faculty of Health Sciences
Johnstone, Jennie J.
Canada, Hamilton
Mcmaster University
Kearon, Clive
Canada, Hamilton
Mcmaster University
Sessler, Daniel I.
United States, Cleveland
Cleveland Clinic Foundation
VanHelder, Tomas
Canada, Hamilton
Mcmaster University
Rao-Melacini, Purnima
Canada, Hamilton
Population Health Research Institute, Ontario
Canada, Hamilton
Mcmaster University
Worster, Andrew S.
Canada, Hamilton
Mcmaster University
Patil, Atul Ashok
India, Pune
Sancheti Institute for Orthopaedics and Rehabilitation
McLean, Richard
Canada, Hamilton
St. Joseph's Healthcare Hamilton
MacDonald, Anne Marie
Canada, Hamilton
St. Joseph's Healthcare Hamilton
Badzioch, Rick
Canada, Hamilton
St. Joseph's Healthcare Hamilton
Devereaux, Philip James
Canada, Hamilton
Population Health Research Institute, Ontario
Canada, Hamilton
Mcmaster University
Statistics
Citations: 102
Authors: 47
Affiliations: 9
Identifiers
Doi:
10.1503/cmaj.130901
ISSN:
08203946
e-ISSN:
14882329
Research Areas
Environmental
Health System And Policy
Noncommunicable Diseases
Violence And Injury
Study Design
Randomised Control Trial
Cohort Study