Ultrasound-Guided Regional Anesthesia by Emergency Physicians for Hip Fractures and Delirium
Bibliographic record
Abstract
Importance: Delirium complicates 20% to 62% of the estimated 1.5 million hip fractures annually. Meta-analyses suggest that point-of-care ultrasound-guided regional anesthesia (POCUS-GRA) may reduce delirium, but uptake by emergency department (ED) physicians is highly variable. Objectives: To measure the impact of a knowledge-to-practice intervention on uptake of POCUS-GRA by ED physicians, incidence and number of days of delirium, analgesic effectiveness, safety, and procedure time. Design, Setting, and Participants: This stepped-wedge cluster randomized clinical trial was conducted at 7 academic EDs from 4 provinces in Canada. The order in which ED physicians were trained at each site was randomized. ED physicians working at least 1 shift per week who did not regularly perform POCUS-GRA and patients aged 65 years and older with a hip fracture who were not delirious on arrival were included. Data were analyzed in August 2025. Intervention: A 2-hour structured training session on fascia iliaca blocks was followed by competency assessment, with a procedure bundle and email reminders provided. Main Outcome and Measures: Incidence of delirium within 7 days of ED presentation was measured using the Confusion Assessment Method, and duration of delirium was measured in days. Results: A total of 208 of 213 ED physicians (97.7%) who assessed 694 eligible patients with hip fracture (median [IQR] age, 81.0 [74.0-88.0] years; 483 female [69.6%]) were trained. Among these patients, 248 individuals were analyzed prior to training per intention-to-treat analysis, including 6 with protocol violations (control group), and 446 individuals after training (intervention group). The intervention increased blocks from 6 of 264 patients (2.2%) to 236 of 446 patients (52.9%) after training, for a change of 51.7%. After adjustment for a priori confounders, time, and clustering by site, delirium risk in the intervention group was reduced (odds ratio, 0.72; 95% CI, 0.57-0.93). Mean days of delirium was not reduced. Among 186 nerve blocks with pain effectiveness data, most nerve blocks were effective (107 nerve blocks [57.5%]with ≥50% pain reduction), quick (median [IQR] time, 15 [12-20] minutes; 113 nerve blocks [90.0%] <25 minutes), and safe (1 minor hematoma). Conclusion and Relevance: In this study, a knowledge-to-practice intervention improved nerve block uptake, and nerve blocks were quick, safe, and mostly effective. Despite suboptimal uptake, the study adds to the evidence that POCUS-GRA reduces delirium. Trial Registration: ClinicalTrials.gov Identifier: NCT02892968.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".