Field Triage of Head Injured Older Adults Taking Anticoagulants or Platelet Inhib

对服用抗凝剂或血小板抑制剂的头部受伤老年人进行现场分类

• 批准号: 8465613
• 负责人: Daniel Kiden Nishijima
• 金额: $ 24.81万
• 依托单位: UNIVERSITY OF CALIFORNIA AT DAVIS
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-30 至 2015-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8465613
• 关键词: Field; Triage; Head; Injured; Older

DESCRIPTION (provided by applicant): ABSTRACT Pre-injury use of anticoagulant and antiplatelet medications is increasingly more common in older adults (55 years and older) with head trauma. Rapid diagnosis of intracranial hemorrhage (tICH) and reversal of anticoagulant effects is crucial in these patients to prevent significant morbidity and mortality. Gaps in knowledge regarding this high risk patient population, as specified by the RFA, include: data on the burden of disease (e.g., prevalence of tICH, neurosurgical interventions, long- term functional outcomes), the accuracy of medication ascertainment by emergency medicine services (EMS) providers, the accuracy of pre-hospital triage criteria to determine the need for 24- hour neurosurgical and intensive care monitoring, and the impact of pre-hospital triage to a trauma center on patient-oriented outcomes. These gaps in knowledge will be addressed through a prospective, longitudinal, county-wide study of older adults with pre-injury anticoagulant or antiplatelet and head trauma that are initially evaluated by EMS providers. The overall objective of this proposal is to improve patient-oriented outcomes for older adults with pre-injury anticoagulant or antiplatelet use and traumatic brain injury through accurate and effective field triage. The aims of this study are: 1) Describe the burden of disease in this patiet population 2) Compare the accuracy of existing and a novel method of medication ascertainment by EMS providers to identify use of anticoagulant or antiplatelet medications 3) Evaluate the utility of current triage criteria (including EMS clinical impression) and compare to newly derived set of criteria specific to this patient population 4) Compare long-term functional outcomes for patients initially triaged to a trauma center versus those triaged to a non-trauma center. We hypothesize a significant proportion of these patients will have poor long-term functional status after TBI, existing methods of medication ascertainment are inaccurate, existing triage criteria will undertriage a significant proportion of these patients, and patients triaged to a trauma center will have better long-term functional status compared to patients triaged to a non-trauma center. Long-term functional status will be determined from 6-month Extended Glasgow Outcome Scores (GOS-E), accuracy of medication ascertainment will be determined by comparison to a reference standard of in-hospital medication ascertainment, accuracy of triage criteria will be determined by the primary outcome of immediate tICH and the secondary outcomes of serious injury (Injury Severity Score greater than 15) and trauma center resource use (ICU admission, major non-orthopedic surgery, and/or in-hospital mortality). PUBLIC HEALTH RELEVANCE: NARRATIVE Older adults taking blood thinning medications who sustain a head injury are at significant risk for very severe bleeding in the brain and poor long-term functional status. This study will address important gaps in this public health priority, including: describing the immediate and long term outcomes of this patient population, determining the most effective method to assess and triage these patients to trauma centers, and to evaluate the impact of pre-hospital triage to trauma centers. The overall goal of this project is improve the health and long-term function of these patients after head trauma.

描述（由申请人提供）： 摘要 在患有头部外伤的老年人（55 岁及以上）中，受伤前使用抗凝剂和抗血小板药物越来越常见。颅内出血 (tICH) 的快速诊断和抗凝作用的逆转对于这些患者来说至关重要，以防止显着的发病率和死亡率。 RFA 指出，关于这一高危患者群体的知识差距包括：疾病负担数据（例如 tICH 患病率、神经外科干预措施、长期功能结果）、急诊医学服务 (EMS) 提供者药物确定的准确性、确定是否需要 24 小时神经外科和重症监护监测的院前分诊标准的准确性，以及 院前分诊到创伤中心对以患者为导向的结果的影响。这些知识差距将通过一项前瞻性、纵向、全县范围的研究来解决，该研究对受伤前接受抗凝或抗血小板治疗的老年人以及头部外伤进行，这些研究最初由 EMS 提供者进行评估。该提案的总体目标是通过准确有效的现场分类，改善受伤前使用抗凝剂或抗血小板药物以及创伤性脑损伤的老年人的以患者为中心的结果。本研究的目的是： 1) 描述该患者群体的疾病负担 2) 比较 EMS 提供者现有的药物确定方法和新的药物确定方法的准确性，以识别抗凝或抗血小板药物的使用 3) 评估当前分诊标准（包括 EMS 临床印象）的实用性，并与新得出的针对该患者群体的标准集进行比较 4) 比较患者的长期功能结果 最初被分类到创伤中心，而那些被分类到非创伤中心。我们假设这些患者中很大一部分在 TBI 后长期功能状态较差，现有的药物确定方法不准确，现有的分诊标准将很大一部分患者分类不足，并且与分诊到非创伤中心的患者相比，分诊到创伤中心的患者将具有更好的长期功能状态。长期功能状态将根据 6 个月扩展格拉斯哥结果评分 (GOS-E) 确定，药物确定的准确性将通过与院内药物确定的参考标准进行比较来确定，分诊标准的准确性将由立即 tICH 的主要结果和严重损伤（损伤严重程度评分大于 15）的次要结果和创伤中心资源使用（ICU 入院、重大损伤）确定 非骨科手术和/或院内死亡率）。 公共卫生相关性：叙述 服用血液稀释药物且头部受伤的老年人面临非常严重的脑出血和长期功能状态不佳的重大风险。这项研究将解决这一公共卫生优先事项中的重要差距， 包括：描述该患者群体的近期和长期结果，确定评估和分流这些患者到创伤中心的最有效方法，以及评估院前分流到创伤中心的影响。该项目的总体目标是改善头部外伤后患者的健康和长期功能。