Anticoagulated Trauma Patients: A Level I Trauma Center's Response to a Growing Geriatric Population

Injured older adults often receive delayed care in the emergency department (ED) because they do not meet criteria for trauma team activation (TTA). This is particularly dangerous for the increasing number of patients taking anticoagulant or antiplatelet (AC/AP) medication at the time of injury. The...

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Bibliographic Details
Published in:The Journal of emergency medicine 2017-10, Vol.53 (4), p.458-466
Main Authors: Mason, Mark D., Spilman, Sarah K., Fuchsen, Elizabeth A., Olson, Sherry D., Sidwell, Richard A., Swegle, James R., Sahr, Sheryl M.
Format: Article
Language:English
Subjects:
Accidental Falls - statistics & numerical data
Aged
Aged, 80 and over
Anticoagulants - adverse effects
Anticoagulants - therapeutic use
anticoagulation
Chi-Square Distribution
Civil Defense - methods
Civil Defense - trends
Emergency Service, Hospital - organization & administration
falls
Female
geriatric patients
Geriatrics - methods
Geriatrics - trends
Humans
Male
Middle Aged
Midwestern United States
overtriage
Platelet Aggregation Inhibitors - adverse effects
Platelet Aggregation Inhibitors - therapeutic use
Registries - statistics & numerical data
Trauma Centers - organization & administration
Trauma Centers - trends
Triage - methods
Triage - standards
undertriage
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Summary:Injured older adults often receive delayed care in the emergency department (ED) because they do not meet criteria for trauma team activation (TTA). This is particularly dangerous for the increasing number of patients taking anticoagulant or antiplatelet (AC/AP) medication at the time of injury. The present study examined improvements in processes of care and triage accuracy when TTA criteria include an escalated response for older anticoagulated patients. A retrospective study was performed at a Level I trauma center. The study population (referred to as A55) included patients aged 55 years or older who were taking an AC/AP medication at the time of injury. Study periods included 11 months prior to the criteria change (Phase 1: July 2013–May 2014; n = 107) and 11 months after the change (Phase 2: July 2014–May 2015; n = 211). Differences were assessed with Kruskal-Wallis and chi-squared tests.Results: More A55 patients received a full or limited TTA after criteria were revised (70% vs. 26%, p 
ISSN:0736-4679
2352-5029
DOI:10.1016/j.jemermed.2017.05.023