Gastroprotection in trauma patients receiving non-steroidal anti-inflammatory drugs
Abstract
BACKGROUND: NSAIDs are commonly used analgesic agents in the orthopaedic trauma setting. Evidence-based guidelines recommend that patients with one or more risk factors for NSAID-associated gastrointestinal (GI) ulcer complications should be prescribed gastroprotective agents to minimise the risk of serious ulcer complications, including gastrointestinal haemorrhage. The purpose of the present audit was to evaluate and improve the adherence to these guidelines in new-NSAID users in a trauma unit at a district general hospital.
METHODS: A retrospective observational cohort study was conducted over an 18-week period to assess pre-intervention practice. Subsequently, an awareness programme, including prescriber and pharmacist education and the use of reminder posters, was implemented. Following this, data were collected prospectively over 9 weeks to assess any change in performance. Assessment involved review of case-notes and prescription charts of all adults (aged ≥ 18 years) who were commenced on regular NSAIDs on or during admission to the Trauma Unit. Patients were risk-stratified according to the number of risk factors, which were defined as age ≥ 65 years, major comorbidity, oral steroids, anticoagulation, history of upper gastrointestinal ulceration or bleeding and prescription above the normal recommended dose of NSAIDs. The American College of Rheumatology guidelines recommend the use of gastroprotective agents when one or more risk factors was present. Prescription…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 644 participants or records.
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