Article Bites: Trauma triage of older adults: Anticoagulants matter

Older adults tend to be under-triaged despite a higher risk of clinically significant injury

This article originally appeared in the Article Bites blog of the National Association of EMS Physicians and is reprinted here with permission.

By Clare Wallner, MD
Infographic by Jeffrey Stirling MSc(c), PCP, @jeffrey_stirlin

Article: Sacramento County Prehospital Research Consortium. Out-of-hospital triage of older adults with head injury: a retrospective study of the effect of adding “anticoagulation or antiplatelet medication use” as a criterion. Ann Emerg Med 2017 Aug;70(2):127-38.

Background and objectives. The CDC field trauma triage guidelines exist to help with appropriate hospital destination decision making, directing those who need it most to a designated trauma center. It is known that older adults tend to be under-triaged despite a higher risk of clinically significant injury. Anticoagulant and antiplatelet use increase this risk and Step 4 of the trauma triage guidelines, special considerations, incorporated language focused on elder adults as well as head injury of any patient using these medications in 2011. This study examines the sensitivity and specificity for intracranial hemorrhage on initial CT as well as death or neurosurgical intervention for patients meeting Steps 1-3 of the guidelines with and without meeting the special considerations within Step 4.

Methods. This was a retrospective chart review of a period of 12 months of 2012, including all EMS agencies that utilize the Sacramento County Trauma Triage Tool within the Sacramento County area. All patients 55 years and older, with isolated head injury, and transported to hospital were included. Those that were interfacility transfers, penetrating head trauma, prisoners, or had no matching hospital data available were excluded. Patients were identified by review of EMS billing data and ICD9 codes.

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