TY - JOUR
T1 - Conscious sedation versus rapid sequence intubation for the reduction of native traumatic hip dislocation
AU - Bommiasamy, Aravind K.
AU - Opel, Dayton
AU - McCallum, Raluca
AU - Yonge, John D.
AU - Perl, Vicente Undurraga
AU - Connelly, Christopher R.
AU - Friess, Darin
AU - Schreiber, Martin A.
AU - Mullins, Richard
N1 - Publisher Copyright:
© 2018 Elsevier Inc.
PY - 2018/11
Y1 - 2018/11
N2 - Background: Traumatic hip dislocations (THD) are a medical emergency. There is debate whether the painful reduction of a dislocated hip should be first attempted using primary conscious sedation (PCS) or primary general anesthesia (PGA) Methods: All cases of native THD from 2006 to 2015 in the trauma registry of a level 1 trauma center were reviewed. The primary outcome was successful reduction of the THD. Results: 67 patients had a native, meaning not a hip prosthesis, THD. 34 (50.7%) patients had successful PCS, 12 (17.9%) failed PCS and underwent reduction following PGA. 21 (31.3%) underwent PGA. Patients in the PGA group were more severely injured. Time to reduction greater than 6 h was associated with PCS failure (Odds ratio (95% confidence interval) 19.75 (2.06,189.10) p = 0.01). Conclusion: Clinicians treating patients with a THD can utilize either PCS or PGA with many patients safely reduced under PCS. However, patients whose hip have been dislocated for more than 6 h are at risk for failure with PCS, and are good candidates for PGA.
AB - Background: Traumatic hip dislocations (THD) are a medical emergency. There is debate whether the painful reduction of a dislocated hip should be first attempted using primary conscious sedation (PCS) or primary general anesthesia (PGA) Methods: All cases of native THD from 2006 to 2015 in the trauma registry of a level 1 trauma center were reviewed. The primary outcome was successful reduction of the THD. Results: 67 patients had a native, meaning not a hip prosthesis, THD. 34 (50.7%) patients had successful PCS, 12 (17.9%) failed PCS and underwent reduction following PGA. 21 (31.3%) underwent PGA. Patients in the PGA group were more severely injured. Time to reduction greater than 6 h was associated with PCS failure (Odds ratio (95% confidence interval) 19.75 (2.06,189.10) p = 0.01). Conclusion: Clinicians treating patients with a THD can utilize either PCS or PGA with many patients safely reduced under PCS. However, patients whose hip have been dislocated for more than 6 h are at risk for failure with PCS, and are good candidates for PGA.
KW - Acute care
KW - Anesthesia
KW - Hip dislocation
KW - Sedation
KW - Trauma
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U2 - 10.1016/j.amjsurg.2018.02.023
DO - 10.1016/j.amjsurg.2018.02.023
M3 - Article
C2 - 29534815
AN - SCOPUS:85043313396
SN - 0002-9610
VL - 216
SP - 869
EP - 873
JO - American journal of surgery
JF - American journal of surgery
IS - 5
ER -