Background Potential Drug–Drug Interactions (DDI) account for many emergency department visits. Polypharmacy, as well as herbal, over-the-counter (OTC) and combination medication may compound this, but these problems are not well researched in low-and-middle-income countries. Objective To compare the incidence of drug–drug interactions and polypharmacy in older and younger patients attending the Emergency Department (ED). Setting The adult ED of a tertiary teaching hospital in Trinidad. Methods A 4 month cross sectional study was conducted, comparing potential DDI in older and younger patients discharged from the ED, as defined using Micromedex 2.0. Main outcome measure The incidence and severity of DDI and polypharmacy (defined as the use of ≥5 drugs simultaneously) in older and younger patients attending the ED. Results 649 patients were included; 275 (42.3%) were ≥65 years and 381 (58.7%) were female. There were 814 DDIs, of which 6 (.7%) were contraindications and 148 (18.2%) were severe. Polypharmacy was identified in 244 (37.6%) patients. Older patients were more likely to have potential DDI (67.5 vs 48.9%) and polypharmacy (56 vs 24.1%). Herbal products, OTC and combination drugs were present in 8, 36.7 and 22.2% of patients, respectively. On multivariate analysis, polypharmacy and the presence of hypertension and ischaemic heart disease were associated with an increased risk of potential DDI. Conclusion Polypharmacy and potential drug–drug interactions are common in ED patients in the Caribbean. Older patients are particularly at risk, especially as they are more likely to be on multiple medications. The association between herbal medication and polypharmacy needs further investigation. This study indicates the need for a more robust system of drug reconciliation in the Caribbean.Electronic supplementary materialThe online version of this article (doi:10.1007/s11096-017-0520-9) contains supplementary material, which is available to authorized users.
PurposeWhile falls are common in older people, causing significant mortality and morbidity, this phenomenon has not been extensively studied in the Caribbean. This study aimed to compare falls in older and younger people in this setting.MethodsWe conducted a prospective observational study of older trauma patients in Trinidad, comparing older and younger patients sustaining falls.Results1432 adult trauma patients were included (1141 aged 18–64 years and 291 aged 65 years and older). Older fallers were more likely to be female (66.7 vs 47.2%; p < 0.001), suffer from multiple pre-existing diseases (24.7 vs 2.4%; p < 0.001) and take multiple medications (16.1 vs 0.8%; p < 0.001). They also sustained more severe injuries and presented with higher acuity than younger fallers. Admission rates were higher among older fallers (29.9 vs 13.1%; p < 0.001).ConclusionsIn our study, older patients who fell were a distinct group from younger falls victims, with unique demographic, clinical and injury related characteristics. Their increased risk of injury within the home, coupled with their propensity for more severe injuries made them a high risk patient group. More research is needed to better understand this patient group and plan specific preventive interventions.Electronic supplementary materialThe online version of this article (doi:10.1007/s00068-017-0818-2) contains supplementary material, which is available to authorized users.
BackgroundSocial risk is rarely evaluated in older emergency department (ED) patients, although its identification can reduce re-attendance.ObjectivesThis study assessed the diagnostic accuracy of the Triage Risk Screening Tool (TRST) in the ED of a developing country.MethodsThe diagnostic accuracy of the TRST to detect elderly adults in need of social service intervention was compared with routine clinical evaluation, using comprehensive evaluation by an experienced social worker as the “gold standard”. The inter-rater reliability of the TRST was assessed on a separate cohort of patients prior to the main study.ResultsThe sensitivity of the TRST was 94.7% versus 55.6% for physician assessment. The TRST had good inter-rater reliability (Cohen’s kappa = .882), and physicians found it easy to use.ConclusionThe TRST provides a rapid means of assessing risk in older ED patients. This study confirmed the validity of this screening tool in a third world setting.
Increased age, blunt trauma, ISS≥25 and increasing RTS were factors found to be associated with increased risk of mortality in major trauma patients in Trinidad and Tobago. The TRISS model in this study was found to be an excellent discriminator between those who had a high chance of survival to those who had a low probability of survival. A multi-center trial is required for validation of trauma prediction tools such
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