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

在老年人（55岁及以上）头部外伤患者中，损伤前使用抗凝血和抗血小板药物越来越普遍。颅内出血（tICH）的快速诊断和抗凝作用的逆转对这些患者至关重要，以防止显著的发病率和死亡率。根据RFA的规定，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）、急诊医疗服务（EMS）提供者确定药物的准确性、院前分诊标准的准确性，以确定是否需要24小时神经外科和重症监护监测，以及院前分诊到创伤中心对以患者为导向的结果的影响。这些知识上的空白将通过一项前瞻性的、纵向的、全县范围的研究来解决，研究对象是有损伤前抗凝血或抗血小板和头部创伤的老年人，这些老年人最初是由EMS提供者评估的。该建议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或抗血小板并创伤性脑损伤的老年人以患者为导向的结果。本研究的目的是：1)描述该患者群体的疾病负担2)比较EMS提供者现有的和一种新的药物确定方法的准确性，以确定抗凝血或抗血小板药物的使用3)评估当前分诊标准的效用（包括EMS临床印象），并比较新衍生的针对该患者群体的一套标准4)比较最初分诊到创伤中心的患者与那些患者的长期功能结果分流到非创伤中心。我们假设这些患者中有很大一部分在TBI后会有较差的长期功能状态，现有的药物确定方法是不准确的，现有的分诊标准会使很大一部分患者的分诊不足，并且经过分诊到创伤中心的患者比经过分诊到非创伤中心的患者有更好的长期功能状态。长期功能状态将由6个月扩展格拉斯哥结局评分（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的主要结局和严重损伤（损伤严重程度评分大于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)。

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.