Conscious sedation versus rapid sequence intubation for the reduction of native traumatic hip dislocation

Aravind K. Bommiasamy, Dayton Opel, Raluca McCallum, John D. Yonge, Vicente Undurraga Perl, Christopher R. Connelly, Darin Friess, Martin Schreiber, Richard Mullins

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
JournalAmerican Journal of Surgery
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Conscious Sedation
Hip Dislocation
Intubation
General Anesthesia
Hip
Hip Prosthesis
Trauma Centers
Registries
Emergencies
Odds Ratio
Confidence Intervals
Wounds and Injuries

Keywords

  • Acute care
  • Anesthesia
  • Hip dislocation
  • Sedation
  • Trauma

ASJC Scopus subject areas

  • Surgery

Cite this

Conscious sedation versus rapid sequence intubation for the reduction of native traumatic hip dislocation. / Bommiasamy, Aravind K.; Opel, Dayton; McCallum, Raluca; Yonge, John D.; Perl, Vicente Undurraga; Connelly, Christopher R.; Friess, Darin; Schreiber, Martin; Mullins, Richard.

In: American Journal of Surgery, 01.01.2018.

Research output: Contribution to journalArticle

Bommiasamy, Aravind K. ; Opel, Dayton ; McCallum, Raluca ; Yonge, John D. ; Perl, Vicente Undurraga ; Connelly, Christopher R. ; Friess, Darin ; Schreiber, Martin ; Mullins, Richard. / Conscious sedation versus rapid sequence intubation for the reduction of native traumatic hip dislocation. In: American Journal of Surgery. 2018.
@article{39f8719fae94408c93304d8134e6f47c,
title = "Conscious sedation versus rapid sequence intubation for the reduction of native traumatic hip dislocation",
abstract = "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.",
keywords = "Acute care, Anesthesia, Hip dislocation, Sedation, Trauma",
author = "Bommiasamy, {Aravind K.} and Dayton Opel and Raluca McCallum and Yonge, {John D.} and Perl, {Vicente Undurraga} and Connelly, {Christopher R.} and Darin Friess and Martin Schreiber and Richard Mullins",
year = "2018",
month = "1",
day = "1",
doi = "10.1016/j.amjsurg.2018.02.023",
language = "English (US)",
journal = "American Journal of Surgery",
issn = "0002-9610",
publisher = "Elsevier Inc.",

}

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

AU - Mullins, Richard

PY - 2018/1/1

Y1 - 2018/1/1

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

UR - http://www.scopus.com/inward/record.url?scp=85043313396&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85043313396&partnerID=8YFLogxK

U2 - 10.1016/j.amjsurg.2018.02.023

DO - 10.1016/j.amjsurg.2018.02.023

M3 - Article

C2 - 29534815

AN - SCOPUS:85043313396

JO - American Journal of Surgery

JF - American Journal of Surgery

SN - 0002-9610

ER -