Do EMS Providers Accurately Ascertain Anticoagulant and Antiplatelet Use in Older Adults with Head Trauma?

Abstract

Objective Prehospital provider assessment of the use of anticoagulant or antiplatelet medications in older adults with head trauma is important. These patients are at increased risk for traumatic intracranial hemorrhage and therefore field triage guidelines recommend transporting these patients to centers capable of rapid evaluation and treatment. Our objective was to evaluate EMS ascertainment of anticoagulant and antiplatelet medication use in older adults with head trauma. Methods A retrospective study of older adults with head trauma was conducted throughout Sacramento County. All 5 transporting EMS agencies and all 11 hospitals in the county were included in the study, which ran from January 2012 to December 2012. Patients ≥55 years who were transported to a hospital by EMS after head trauma were included. We excluded patients transferred between two facilities, patients with penetrating head trauma, prisoners, and patients with unmatched hospital data. Anticoagulant and antiplatelet use were categorized as: warfarin, direct oral anticoagulants (DOAC; dabigatran, rivaroxaban, and apixaban), aspirin, and other antiplatelet agents (e.g., clopidogrel, ticagrelor). We calculated the percent agreement and kappa statistic for binary variables between EMS and emergency department (ED)/hospital providers. A kappa statistic ≥0.60 was considered acceptable agreement. Results After excluding 174 (7.6%) patients, 2,110 patients were included for analysis; median age was 73 years (interquartile range 62–85 years) and 1,259 (60%) were male. Per ED/hospital providers, the use of any anticoagulant or antiplatelet agent was identified in 595 (28.2%) patients. Kappa statistics between EMS and ED/hospital providers for the specific agents were: 0.76 (95% CI 0.71–0.82) for warfarin, 0.45 (95% CI 0.19–0.71) for DOAC agents, 0.33 (95% CI 0.28–0.39) for aspirin, and 0.51 (95% CI 0.42–0.60) for other antiplatelet agents. Conclusions The use of antiplatelet or anticoagulant medications in older adults who are transported by EMS for head trauma is common. EMS and ED/hospital providers have acceptable agreement with preinjury warfarin use but not with DOAC, aspirin, and other antiplatelet use.

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

“…26 The study was conducted primarily in Sacramento County, which encompasses 994 square miles and has a resident population of 1,445,327 (2010 census). Sacramento County is served by 5 EMS agencies that respond to 9-1-1 medical emergencies.…”

“…It is possible that a variety of factors such as limited access to medication lists, language barriers, altered mental status, or dementia may limit the ability of EMS providers to accurately ascertain medication use and influence hospital transport decisions. 26,36 We did not report information regarding trauma activations or the timing of interventions at trauma and non-trauma centers. Finally, at the time of the study, direct oral anticoagulants were recently approved by the Federal Drug Administration and therefore we have very few patients with preinjury direct oral anticoagulant use.…”

Advanced mobile prehospital nursing care for elderly people post-trauma: integrative review

“…Do EMS providers accurately ascertain anticoagulant and antiplatelet use in older adults with head trauma? (42) To identify if health professionals have evaluated the use of anticoagulant and antiplatelet for severe brain injury elderly patients.…”

Atendimento pré-hospitalar móvel avançado para idosos pós-trauma: evidências para a construção de um protocolo assistencial de enfermagem

“…• Coletar dados sobre mecanismo do trauma (WILES; DAY; HARRIS, 2016), o uso de medicamentos (NISHIJIMA, et al, 2016) e a idade (ASSIS et al, 2016).…”

“…Não postergar o transporte (PHTLS, 2011). Coletar dados sobre doenças em tratamento, medicamentos de uso contínuo (ATLS, 2012;NISHIJIMA, et al, 2016;BULECHEK et al, 2016;LMTS, 2017), mecanismo do trauma (WILES; DAY; HARRIS, 2016); líquidos e alimentos ingeridos; imunização contra tétano (ATLS, 2012) e dados sociais do idoso (p. ex., com quem e onde vive, presença de cuidadores e de familiares) (ASSIS et al, 2016).…”