Details:

Alternative Title:
Prehosp Emerg Care
Personal Author:
Nishijima, Daniel K. ; Gaona, Samuel ; Waechter, Trent ; Maloney, Ric ; Bair, Troy ; ... More +
Nishijima, Daniel K. ; Gaona, Samuel ; Waechter, Trent ; Maloney, Ric ; Bair, Troy ; Blitz, Adam ; Elms, Andrew R. ; Farrales, Roel D. ; Howard, Calvin ; Montoya, James ; Bell, Jeneita M. ; Coronado, Victor C. ; Sugerman, David E. ; Ballard, Dustin W. ; Mackey, Kevin E. ; Vinson, David R. ; Holmes, James F. ; Less -
Description:
Objective Prehospital provider assessment of the use of anticoagulant or antiplatelet medications in older adults with head trauma is important. These patients are at increased risk for traumatic intracranial hemorrhage and therefore field triage guidelines recommend transporting these patients to centers capable of rapid evaluation and treatment. Our objective was to evaluate EMS ascertainment of anticoagulant and antiplatelet medication use in older adults with head trauma. Methods A retrospective study of older adults with head trauma was conducted throughout Sacramento County. All 5 transporting EMS agencies and all 11 hospitals in the county were included in the study, which ran from January 2012 to December 2012. Patients ≥55 years who were transported to a hospital by EMS after head trauma were included. We excluded patients transferred between two facilities, patients with penetrating head trauma, prisoners, and patients with unmatched hospital data. Anticoagulant and antiplatelet use were categorized as: warfarin, direct oral anticoagulants (DOAC; dabigatran, rivaroxaban, and apixaban), aspirin, and other antiplatelet agents (e.g., clopidogrel, ticagrelor). We calculated the percent agreement and kappa statistic for binary variables between EMS and emergency department (ED)/hospital providers. A kappa statistic ≥0.60 was considered acceptable agreement. Results After excluding 174 (7.6%) patients, 2,110 patients were included for analysis; median age was 73 years (interquartile range 62–85 years) and 1,259 (60%) were male. Per ED/hospital providers, the use of any anticoagulant or antiplatelet agent was identified in 595 (28.2%) patients. Kappa statistics between EMS and ED/hospital providers for the specific agents were: 0.76 (95% CI 0.71–0.82) for warfarin, 0.45 (95% CI 0.19–0.71) for DOAC agents, 0.33 (95% CI 0.28–0.39) for aspirin, and 0.51 (95% CI 0.42–0.60) for other antiplatelet agents. Conclusions The use of antiplatelet or anticoagulant medications in older adults who are transported by EMS for head trauma is common. EMS and ED/hospital providers have acceptable agreement with preinjury warfarin use but not with DOAC, aspirin, and other antiplatelet use.
Subject:
[+]
Aged
Aged, 80 And Over
Article
Craniocerebral Trauma
Female
Humans
Intracranial Hemorrhage, Traumatic
Male
Medical History Taking
Middle Aged
Retrospective Studies
Triage

Source:
Prehosp Emerg Care. 21(2):209-215.
Pubmed ID:
27636529
Pubmed Central ID:
PMC5336488
Document Type:
Journal Article ;
Funding:
KL2 TR000134/TR/NCATS NIH HHS/United States ; L30 TR000286/TR/NCATS NIH HHS/United States ; U01 CE002177/CE/NCIPC CDC HHS/United States ; UL1 TR000002/TR/NCATS NIH HHS/United States ;
KL2 TR000134/TR/NCATS NIH HHS/United States ; L30 TR000286/TR/NCATS NIH HHS/United States ; U01 CE002177/CE/NCIPC CDC HHS/United States ; UL1 TR000002/TR/NCATS NIH HHS/United States ; Less -
Place as Subject:
United States ;
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:d9709ed6422c6f19f09a523c2a9910f0354d555911465df04d99f29746a5543b
File Type:

Supporting Files

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  	nihms838020f1.gif	gif
  	nihms838020f1.jpg	jpeg
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