Ultrasound-Guided Regional Anesthesia by Emergency Physicians for Hip Fractures and Delirium: A Randomized Clinical Trial
Primary result · Delirium incidence within 7 daysResult — go to the resultOdds ratio 0.72 95% CI 0.57–0.93Authors' conclusion
In this study, a knowledge-to-practice intervention improved nerve block uptake, and nerve blocks were quick, safe, and mostly effective.
Study context
- Population
- Patients aged 65 years and older with a hip fracture, not delirious on arrival, and emergency department (ED) physicians not regularly performing point-of-care ultrasound-guided regional anesthesia (POCUS-GRA); 7 academic EDs in Canada208 of 213 ED physicians trained
- Participants
- 694 patients
- Comparison
- Knowledge-to-practice intervention vs pre-training care
- Interventionn = 446
- Controln = 248reference
- Primary endpoint
- Incidence of delirium (Confusion Assessment Method) and duration of delirium in days
- Follow-up
- Within 7 days of ED presentation
Methodological detailsstepped-wedge, cluster randomized, multicentre (7 academic EDs, 4 provinces)
- Stepped-wedge
- Cluster randomized
- Multicentre (7 academic EDs, 4 provinces)
Primary result
Delirium incidence within 7 days
Odds ratio
0.72
95% CI 0.57–0.93
Interventionvs Control
OR 0.72 (95% CI 0.57–0.93)
As reported in the abstract
Further findings
Nerve block uptake
change 51.7%
- Nerve block uptake: 6 of 264 before training vs 236 of 446 after training
Mean days of delirium
- Mean days of delirium was not reduced
Analgesic effectiveness (≥50% pain reduction), among 186 nerve blocks with pain effectiveness data
- Nerve blocks with ≥50% pain reduction
- 107 [57.5%]
Procedure time of nerve blocks
- Median [IQR] time, minutes
- 15 [12-20]
- Nerve blocks <25 minutes
- 113 [90.0%]
Safety
Nerve block complications
- Minor hematoma
- 1
Original publication
Ultrasound-Guided Regional Anesthesia by Emergency Physicians for Hip Fractures and Delirium: A Randomized Clinical Trial. JAMA Netw Open. Published 1 December 2025. doi:10.
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