Field Triage of Older Adults Who Experience Traumatic Brain Injury

描述(申请人提供)：创伤性脑损伤(TBI)是老年人残疾和死亡的主要来源。尤其令人担忧的是，老年人最常在低机械性损伤后持续脑损伤，如从站立高度坠落，并经常使用抗凝剂和血小板抑制剂，这将使他们面临更糟糕的临床结果的风险。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，除非找到改善这一独特人群预后的方法，否则老年脑外伤仍将是发病率和死亡率的主要来源。在这项拟议的研究中，我们的总体目标是描述目前对疑似脑外伤的老年(年龄55岁)患者的院前创伤分诊流程，确定抗凝剂和血小板抑制剂对与脑外伤相关的创伤中心服务需求的影响，并确定在院前环境中可行的新的脑外伤筛查策略。我们将在我们长期和高度成功的EMS研究实验室的基础上再接再厉，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，从包括多个EMS机构、城乡环境以及创伤中心和非创伤中心的大型多县集水区收集数据。在本研究中，我们将：1)确定候选神经病学评分标准，以最大限度地检测高危老年脑损伤患者；2)描述急救服务提供者当前用于识别疑似脑外伤患者以及接受抗凝剂和/或血小板抑制剂治疗的老年患者的创伤分诊流程；3)评估接受抗凝剂和/或血小板抑制剂治疗的老年脑损伤患者的公共健康负担；4)评估新的院前神经学筛查策略的预测能力，以确定院前环境中需要脑外伤相关创伤中心护理的高危老年脑损伤患者。这项研究的结果有可能改变院前环境的临床实践，因为它为未来在服用抗凝剂或血小板抑制剂的老年人中识别脑外伤的建议提供了信息。

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.