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

描述(申请人提供)：损伤前使用抗凝剂和抗血小板药物在患有头部创伤的老年人(55岁及以上)中越来越普遍。对于这些患者来说，快速诊断颅内出血(TICH)并逆转抗凝效果对于预防显著的发病率和死亡率至关重要。根据RFA的规定，关于这一高危患者群体的知识差距包括：关于疾病负担的数据(例如，TICH的患病率、神经外科干预措施、长期功能结果)、急诊医疗服务(EMS)提供者确定用药的准确性、确定是否需要24小时神经外科和重症监护的院前分诊标准的准确性、以及创伤中心院前分诊对以患者为中心的结果的影响。这些知识差距将通过一项前瞻性的、纵向的、全县范围的研究来解决，研究对象是受伤前服用抗凝剂或抗血小板药物的老年人和头部创伤患者，这些研究最初由EMS提供者进行评估。这项建议的总体目标是通过准确和有效的现场分诊，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以患者为中心的预后。本研究的目的是：1)描述这一特殊人群的疾病负担2)比较EMS提供者现有的和一种新的用药确定方法的准确性，以确定抗凝剂或抗血小板药物的使用3)评估当前分诊标准(包括EMS的临床印象)的有效性，并与新得出的一套针对该患者群体的标准进行比较4)比较最初被分诊到创伤中心的患者与那些被分派到非创伤中心的患者的长期功能结果。我们假设，这些患者中有相当大一部分在创伤后的长期功能状态较差，现有的用药确定方法不准确，现有的分诊标准将对相当大比例的患者进行分流，与被分流到非创伤中心的患者相比，被分流到创伤中心的患者将有更好的长期功能状态。长期功能状态将根据6个月的扩展格拉斯哥预后评分(GOS-E)来确定，用药确定的准确性将通过与住院用药确定的参考标准进行比较来确定，分诊标准的准确性将由即时TICH的主要结果以及严重损伤(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)的次要结果确定。

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).