Field Triage of Older Adults Who Experience Traumatic Brain Injury

描述（由申请人提供）：摘要创伤性脑损伤（TBI）是老年人残疾和死亡的主要原因。特别值得关注的是，老年人在低机制损伤（如从站立高度跌落福尔斯）后最常发生TBI，并且经常使用抗凝剂和血小板抑制剂，这使他们面临更差临床结局的风险。随着老年人口的增长以及抗凝剂和血小板抑制剂的广泛使用，老年人中的TBI将继续成为发病率和死亡率的主要来源，除非确定方法来改善这一独特人群的结局。我们在这项拟议研究的总体目标是描述目前院前创伤分流过程中的老年人（年龄55岁）怀疑创伤性脑损伤患者，以确定抗凝血剂和血小板抑制剂对创伤中心服务的创伤性脑损伤相关需求的影响，并确定新的创伤性脑损伤筛查策略，是可行的用于院前设置。我们将建立在我们的长期和非常成功的EMS研究实验室，专门专注于受伤患者的分流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，多县集水区，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收集数据。在这项研究中，我们将：1）识别候选神经学量表以最大化高风险老年TBI患者的检测; 2）表征EMS提供者用于识别疑似TBI的老年患者和服用抗凝剂和/或血小板抑制剂的患者的当前创伤分类过程; 3）评估服用抗凝剂和/或血小板抑制剂的老年EMS患者中TBI的公共卫生负担; 4）评估新型院前神经学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风险老年TBI患者。这项研究的结果有可能改变院前环境中的临床实践，为今后在服用抗凝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.