European Geriatric Medicine - Supplement 1 - Volume 7 - October 2016

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Results: Mean age was 85.6 ( ± 6.9) years, 89.2% were women. Overall
1-year mortality was 23.2%. Sensitivity to predict 1-year mortality was
53% for AChI, 86% for ASA and 91% for NHFS. Unadjusted 1-year
mortality Odds Ratio (OR) (CI 95%) were 2.16 (1.48–3.15) for AChI, 3.29
(1.88– 5.78) for ASA, and 4.99 (2.67–9.31) for NHFS (all with p < 0.001).
Age and sex adjusted 1-year mortality OR (CI 95%) were 1.90 (1.30–
2.81) for AChI (p = 0.001), 2.90 (1.64–5.12) for ASA (p < 0.001), and
4.02 (2.10 –7.81) for NHFS (p < 0.001).
Conclusions: The three scoring instruments analysed showed a good
accuracy for predicting 1-year mortality. The Nothinghan Hip Fracture
Score showed the best discriminative performance. (Founded with
grants from IdiPAZ and Nestle Health Science, 2013)
P-837
Comparison of key characteristic differences of younger versus
older patients admitted with major trauma
K. Nourein, D. Aw. Nottingham University Hospitals NHS Trust
Introduction: There is an increasing proportion of elderly patients
admitted with major trauma. We looked at patients admitted with
trauma to a national major trauma centre in the East Midlands, United
Kingdom. We aimed to find out key characteristic differences between
those 65 and over versus those younger.
Method: Data was analysed retrospectively though Trauma and
Audit Research Network (TARN) and medway database for patients
admitted to Queen’ s Medical Centre Nottingham from April 2014 to
March 2015.
Results: There were 1514 patients admitted with trauma, of which
589 (38.90%) were 65 and over. The mechanisms of injury in those
≥ 65 yrs were mainly: 68.93% fall <2 metres; 14.10% fall >2 metres
and 15.62% vehicular incidents, whilst in those <65 yrs it was mostly
due to vehicular incidents (43.57%), fall <2 metres (32.97%), and fall >2
metres (11.68%). The average length of stay (LOS) was 17 days for
the older age group versus 13 days for the younger age group. The
mortality amongst the older age group was 13.24% as compared with
3.14% in the younger counterparts, Of the older patients ,152 (56%)
went back to their usual place of residence as compared to 562 (84%)
of the younger patients. Percentage distribution according to injury
severity score (ISS) was similar in both groups.
Conclusion: A significant proportion of patients admitted with trauma
are elderly. Although elderly are more likely to have low impact injury,
they have relatively similar ISS scores, longer LOS, higher mortality
and are less likely to be discharged home compared to their younger
counterparts.
P-838
A retrospective study of regional anaesthesia with continuous
peripheral nerve blocks to enhance recovery in elderly patients
following hip fracture fixation – the Singapore experience
P.W. Wong1, S.B. Loganathan1, W.H. Bin1, E. Seet1, C. Quek2, L. Chua4,
Y.D. Chen5, U.M. Jagadish3. 1Department of Anaesthesia, Khoo Teck Puat
Hospital, Alexandra Health Systems, 2Nursing Administration, Khoo Teck
Puat Hospital, Alexandra Health Systems, 3Department of Physiotherapy,
Khoo Teck Puat Hospital, Alexandra Health Systems, 4Department of
Orthopaedics, Khoo Teck Puat Hospital, Alexandra Health Systems,
5Department of Geriatric Medicine, Khoo Teck Puat Hospital, Alexandra
Health Systems, Singapore
Introduction: In late 2014, KTPH spearheaded the first tripartite
Hip Fracture Unit (HFU) in Singapore, where Geriatrics, Orthopaedics
and Anaesthesia, along with allied health, sought to integrate and
improve hip fracture care. Recognising that pain management is a
major cornerstone, we championed the concept of optimal analgesia
throughout the patient journey, not just perioperatively, and focused
on early ambulation. While opioids and single injection nerve blocks
have been advocated 1,2, we explored the routine use of continuous
peripheral nerve blocks (CPNB).
Methods: Retrospective analysis of 470 patients admitted under the
HFU conducted from November 2014 to January 2016.
Results: A total of 374 patients who underwent hip fixation received
CPNB to address fracture or surgical pain. Patients with CPNB had
optimal analgesia scores, able to ambulate at mean 2.3+/−1.9 post-
operative day (POD) compared with international data of mean 5
days, with a comparable average age 79.6+/−8 years vs 80+/−7 years
2,3. Length of stay remained stable despite having increasingly
older (mean increased by 2 years) and complex patients (increase of
American Society of Anesthesiologists physical status score (ASA) 3 by
22% and ASA 4 by 7%). Patient satisfaction scores were consistently
near 100%. No CPNB related infections or unwarranted motor blockade
were found.
Conclusion: A paradigm shift towards a functional-targeted continu-
ous painmanagement has improved the quality of care for increasingly
complex HFU patients, and promoted early ambulation and recovery.
Our innovative use of CPNB is a safe and potentially newanalgesia gold
standard for hip fracture management.
References
1. Australian and New Zealand Guideline for Hip Fracture Care-
Improving outcomes in hip fracture care for adults . Australian
Government: National Health and Medical Research Council: 2014.
2. Hip fracture management. NICE guidelines 2014.
3. Siu AL, Penrod JD et al. Early Ambulation after Hip Fracture: effects
on function and mortality. Arch Intern Med 2006: 166(7): 766–771.
P-839
Chest X-ray for hip fractures: are we missing anything?
M.J. Rawle1, L. Mieiro2, R. Purcell2. 1King’s College London, 2Department
of Medicine for Elderly People, Whipps Cross University Hospital, Barts
Health NHS Trust, London, UK
Background: Many feel that a pre-operative chest x-ray (CXR) in
hip fracture patients is important to optimise management and
avoid delay to surgery [1]. However, relevance of CXR for otherwise
presumed healthy individuals aged 60 and older is contentious [1][2].
The authors investigate the outcome of routine CXR for hip fracture
patients in clinical practice.
Methods: Exploratory analysis of routinely collected data in an
orthogeriatrics ward of a British University Hospital over a 5-month
period. All patients aged 60 and over admitted with hip fracture
were included. CXRs conducted at presentation were reviewed by
Radiologist and Geriatrician for pathology and then contrasted with
any repeat CXR conducted during the same admission.
Results: 130 cases retrieved, of which 127 had an initial CXR.
Pathology was identified in 28% of cases. During the same admission,
47% required repeat CXR. Comparison was drawn to the initial x-ray.
Of these, a further 22 cases showed new pathology. More than a half
showed new consolidation. Other findings included pulmonary
oedema and lung nodules. Overall, 56% of the initial CXRs conducted
were relevant in the immediate or later management. Those more
likely to have positive findings were older, frail and had dementia.
Nonetheless, pathology was evident across all age groups.
Conclusions: Almost a third of patients admitted with hip fracture
had a pathological CXR. Half of conducted CXRs had a direct impact on
the patients’ medical management. Therefore, a routine pre-operative
CXR as a baseline for patients over 60 should be included in hip
fracture clinical pathways.
References
1. British Orthopaedic Association. The care of patients with hip
fractures. The Blue Book. September 2007.
2. Royal College of Radiologists. Pre-op CXR for Elective Surgery. Online
guidance, 2008.
Poster presentations / European Geriatric Medicine 7S1 (2016) S29–S259 S250