Rationale and design of the HIP fracture Accelerated surgical TreaTment And Care tracK (HIP ATTACK) Trial: a protocol for an international randomised controlled trial evaluating early surgery for hip fracture patients

Flavia K Borges, Mohit Bhandari, Ameen Patel, Victoria Avram, Ernesto Guerra-Farfán, Alben Sigamani, Masood Umer, Maria Tiboni, Anthony Adili, John Neary, Vikas Tandon, Parag K Sancheti, AbdelRahman Lawendy, Richard Jenkinson, Mmampapatla Ramokgopa, Bruce M Biccard, Wojciech Szczeklik, Chew Yin Wang, Giovanni Landoni, Patrice ForgetEkaterine Popova, Gavin Wood, Aamer Nabi Nur, Bobby John, Paweł Ślęczka, Robert J Feibel, Mariano Balaguer-Castro, Benjamin Deheshi, Mitchell Winemaker, Justin de Beer, Richard Kolesar, Jordi Teixidor-Serra, Jordi Tomas-Hernandez, Michael McGillion, Harsha Shanthanna, Iain Moppett, Jessica Vincent, Shirley Pettit, Valerie Harvey, Leslie Gauthier, Kim Alvarado, P J Devereaux

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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.


Original languageEnglish
Article numbere028537
JournalBMJ Open
Issue number4
Publication statusPublished - 1 May 2019


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