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

描述（由申请人提供）：摘要在头部创伤的老年人（55岁及以上）中，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预防这些患者的显著发病率和死亡率至关重要。根据RFA的规定，关于这一高风险患者人群的知识差距包括：关于疾病负担的数据（例如，tICH的患病率、神经外科干预、长期功能结局）、急诊医学服务（EMS）提供者药物确定的准确性、确定24小时神经外科和重症监护监测需求的院前分诊标准的准确性以及创伤中心院前分诊对患者导向结局的影响。这些知识上的差距将通过一项前瞻性、纵向、全县范围的研究来解决，该研究对受伤前抗凝剂或抗血小板和头部创伤的老年人进行了初步评估。本提案的总体目标是通过准确有效的现场分诊，改善损伤前使用抗凝剂或抗血小板药物和创伤性脑损伤的老年人的患者导向结局。本研究的目的是：1）描述该患者人群的疾病负担2）比较EMS提供者确定抗凝或抗血小板药物使用的现有和新药物确定方法的准确性3）评价当前分类标准的实用性（包括EMS临床印象），并与新衍生的该患者人群特异性标准集进行比较。最初分诊到创伤中心的患者与分诊到非创伤中心的患者的长期功能结局。我们假设这些患者中有很大一部分在TBI后长期功能状态较差，现有的药物确定方法不准确，现有的分诊标准将对这些患者中的很大一部分进行分流，与分流到非创伤中心的患者相比，分流到创伤中心的患者将具有更好的长期功能状态。将根据6个月扩展格拉斯哥结局评分（GOS-E）确定长期功能状态，将通过与住院药物确定的参考标准进行比较来确定药物确定的准确性，分类标准的准确性将由即刻tICH的主要结局和严重损伤的次要结局决定（损伤严重度评分大于15）和创伤中心资源使用（ICU入院、重大非骨科手术和/或住院死亡率）。 公共卫生相关性：老年人服用血液稀释药物谁维持头部受伤是在非常严重的脑出血和长期功能状态差的重大风险。这项研究将解决这一公共卫生优先事项中的重要差距， 包括以下步骤：描述该患者人群的近期和长期结果，确定评估和将这些患者分诊到创伤中心的最有效方法，并评估院前分诊对创伤中心的影响。该项目的总体目标是改善头部创伤后这些患者的健康和长期功能。

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.