Field Triage of Older Adults Who Experience Traumatic Brain Injury

摘要创伤性脑损伤（TBI）是老年人致残和死亡的主要原因。特别值得关注的是，老年人最常在低机制损伤后发生tbi，如从站立高度坠落，并且经常使用抗凝血剂和血小板抑制剂，这使他们面临更差临床结果的风险。随着老年人口的增长以及抗凝血剂和血小板抑制剂的广泛使用，除非找到改善这一独特人群预后的方法，否则老年人TBI将继续成为发病率和死亡率的主要来源。我们在这项研究中提出的总体目标是描述目前老年（55岁）疑似TBI患者的院前创伤分诊过程，确定抗凝血剂和血小板抑制剂对创伤中心服务需求的影响，并确定在院前环境中可行的新型TBI筛查策略。我们将建立在我们长期以来非常成功的EMS研究实验室的基础上，该实验室专门专注于受伤患者的分类和老年患者的院前护理。我们将采用定性和定量相结合的方法，从一个大的、多县的集水区收集数据，包括多个EMS机构、城市和农村环境，以及创伤中心和非创伤中心。在本研究中，我们将：1)确定候选神经学量表，以最大限度地检测高风险的老年TBI患者；2)描述EMS提供者目前用于识别老年疑似TBI患者和服用抗凝血剂和/或血小板抑制剂患者的创伤分诊过程；3)评估使用抗凝剂和/或血小板抑制剂的老年EMS患者TBI的公共卫生负担；4)评估新型院前神经系统筛查策略的预测能力，以识别院前环境中需要TBI相关创伤中心护理的高危老年TBI患者。这项研究的发现有可能改变院前的临床实践，为未来在服用抗凝血剂或血小板抑制剂的老年人中识别TBI提供建议。

DESCRIPTION (provided by applicant): Abstract Traumatic brain injury (TBI) is major source of disability and death for older adults. Of particular concern is that older adults most frequentl sustain TBIs after low-mechanism injuries, such as falls from standing height, and frequently use anticoagulants and platelet inhibitors, which place them at risk for worse clinical outcomes. With the growth of the older adult population and the expanding use of anticoagulants and platelet inhibitors, TBI among older adults will continue to be a major source of morbidity and mortality unless methods are identified to improve outcomes in this unique population. Our overall goal in this proposed study is to describe the current prehospital trauma triage process for older adult (agee55) patients with suspected TBI, to identify the effect of anticoagulants and platelet inhibitors on TBI-related need for trauma center services, and to identify novel TBI screening strategies that are feasible for use in the prehospital setting. We will build upon our long-standing and highly successful EMS research laboratory that has specifically focused on the triage of injured patients and the prehospital care of older patients. We will employ a combination of qualitative and quantitative methods, collecting data from a large, multi-county catchment area that includes multiple EMS agencies, urban and rural environments, as well as trauma centers and non-trauma centers. In this study, we will: 1) identify candidate neurologic scales to maximize detection of high-risk older adult TBI patients; 2) characterize the current trauma triage process used by EMS providers to identify older patients with suspected TBI and patients taking anticoagulants and/or platelet inhibitors; 3) assess the public health burden of TBI among older adult EMS patients taking anticoagulants and/or platelet inhibitors; 4) assess the predictive ability of novel prehospital-based neurologic screening strategies to identify high-risk older adult TBI patients in the prehospital setting who require TBI- related trauma center care. Findings from this study have the potential to shift clinical practice in the prehospital setting by informing future recommendations for the identification of TBI among older adults taking anticoagulants or platelet inhibitors. PUBLIC HEALTH RELEVANCE: Public Health Statement Traumatic brain injury (TBI) among older adults using anticoagulants and platelet inhibitors is a major source of morbidity and mortality, but very little is understood about the epidemiology of this injury in this population, he trauma triage processes used by prehospital providers for these patients, or the optimal prehospital triage algorithm for this population. Our overall goal in this study is to describe the current prehospital trauma triage process for older adult (agee55) patients with suspected TBI and to identify a novel triage algorithm that is feasible for use in the prehospital setting. Findigs from this study have the potential to shift clinical practice in the prehospital setting by informig future recommendations for the identification and triage of older adults taking anticoagulants and/or platelet inhibitors who suffer traumatic brain injury.