Key result
The HIP ATTACK trial is a protocol for an RCT evaluating if accelerated surgery (within 6 hours) reduces 90-day mortality and major complications versus standard care in 3000 hip fracture patients.
Why the study?
Hip fractures carry high mortality, and observational data suggest early surgery can improve outcomes, but randomized trial evidence was lacking.
Does accelerated medical assessment and surgical repair reduce all-cause mortality and major perioperative complications in patients ≥45 years of age with a hip fracture?
RCT (n=3,000)
parallel group
Yes
Does accelerated medical assessment and surgical repair reduce all-cause mortality and major perioperative complications in patients ≥45 years of age with a hip fracture?
This paper describes the rationale and design of the HIP ATTACK trial, which will evaluate whether accelerated surgery (within 6 hours) improves 90-day mortality and perioperative complications in hip fracture patients.
INTRODUCTION: Annually, millions of adults suffer hip fractures. The mortality rate post a hip fracture is 7%-10% at 30 days and 10%-20% at 90 days. Observational data suggest that early surgery can improve these outcomes in hip fracture patients. We designed a clinical trial-HIP fracture Accelerated surgical TreaTment And Care tracK (HIP ATTACK) to determine the effect of accelerated surgery compared with standard care on the 90-day risk of all-cause mortality and major perioperative complications. METHODS AND ANALYSIS: HIP ATTACK is a multicentre, international, parallel group randomised controlled trial (RCT) that will include patients ≥45 years of age and diagnosed with a hip fracture from a low-energy mechanism requiring surgery. Patients are randomised to accelerated medical assessment and surgical repair (goal within 6 h) or standard care. The co-primary outcomes are (1) all-cause mortality and (2) a composite of major perioperative complications (ie, mortality and non-fatal myocardial infarction, pulmonary embolism, pneumonia, sepsis, stroke, and life-threatening and major bleeding) at 90 days after randomisation. All patients will be followed up for a period of 1 year. We will enrol 3000 patients. ETHICS AND DISSEMINATION: All centres had ethics approval before randomising patients. Written informed consent is required for all patients before randomisation. HIP ATTACK is the first large international trial designed to examine whether accelerated surgery can improve outcomes in patients with a hip fracture. The dissemination plan includes publishing the results in a policy-influencing journal, conference presentations, engagement of influential medical organisations, and providing public awareness through multimedia resources. TRIAL REGISTRATION NUMBER: NCT02027896; Pre-results.
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Borges et al. (2019) conducted an RCT in hip fracture (n=3,000). accelerated medical assessment and surgical repair (goal within 6 h) vs. standard care was evaluated on (1) all-cause mortality and (2) a composite of major perioperative complications at 90 days. The HIP ATTACK trial is a protocol for an RCT evaluating if accelerated surgery (within 6 hours) reduces 90-day mortality and major complications versus standard care in 3000 hip fracture patients.
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