Patterns of analgesia for fractured neck of femur in Australian emergency departments

Objectives: Fractured neck of femur is a common ED problem and poor pain management in this patient group can contribute significantly to their morbidity. The present study aims to describe current practices for managing pain in patients with fractured neck of femur in Australian ED and to identify real or potential barriers to providing analgesia. Methods: Hospitals were invited to participate in a retrospective medical chart audit of patients with fractured neck of femur. At each site, 20 cases were randomly selected from the previous 12 months. Patient demographics, timing, type and method of analgesia in ED, use of pain scales and perceived barriers to analgesia were extracted from the medical chart. Results: Data on 646 patients were collected from 36 hospitals in five Australian states. Most patients were elderly with a preponderance of women. One hundred and eighty-five (28.6%) patients had no record of analgesia administration in the ED and almost half of these had also not received prehospital analgesia. Intravenous morphine was the most frequently used analgesic and only 45 patients received a nerve block in the ED. The median time to first analgesia was 75 min after ED arrival. The most commonly reported barriers reported were cognitive impairment and language difficulties. Conclusions: Oligoanalgesia for fracture neck of femur in Australian ED is common and time to analgesia tends to be relatively slow. Regional techniques are infrequently used despite their recognized efficacy. Strategies for improving pain management in this cohort of ED patients need to be explored.