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J Neurotrauma. 2017 Nov 6. doi: 10.1089/neu.2017.5232. [Epub ahead of print]

The incidence of traumatic intracranial hemorrhage in head-injured older adults transported by EMS with and without anticoagulant or antiplatelet use.

Author information

1
University of California, Davis , Emergency Medicine , 4150 V. Street, PSSB 2100 , Sacramento, California, United States , 95817 ; dnishijima@ucdavis.edu.
2
University of California, Davis , Emergency Medicine, Sacramento, California, United States ; sdgaona@ucdavis.edu.
3
City of Sacramento Fire Department, Sacramento, California, United States ; TWaechter@roseville.ca.us.
4
Sacramento Metropolitan Fire Department, Sacramento, California, United States ; maloney.ric@metrofire.ca.gov.
5
American Medical Response, Sacramento, California, United States ; Adam.Blitz@amr.net.
6
Kaiser Permanente South Sacramento Medical Center, Sacramento, California, United States ; Andrew.R.Elms@kp.org.
7
Mercy General Hospital, 22556, Sacramento, California, United States ; Roel.Farrales@DignityHealth.org.
8
Sutter Medical Center Sacramento, 24370, Sacramento, California, United States ; montoyamd@mac.com.
9
Cosumnes Community Services District Fire Department, Sacramento, California, United States ; TroyBair@csdfire.com.
10
City of Folsom Fire Department, Sacramento, California, United States ; folsomfire@folsom.ca.us.
11
University of California, Davis , Emergency Medicine, Sacramento, California, United States ; mgilbert@ucdavis.edu.
12
University of California, Davis , Emergency Medicine, Sacramento, California, United States ; rtrajano@ucdavis.edu.
13
University of California, Davis , Emergency Medicine, Sacramento, California, United States ; kmhatchel@ucdavis.edu.
14
Centers for Disease Control and Prevention, 1242, Atlanta, Georgia, United States ; mgf7@cdc.gov.
15
Centers for Disease Control and Prevention, 1242, Atlanta, Georgia, United States ; hqp8@cdc.gov.
16
CDC , 4770 Buford Hwy , MS F62 , Atlanta, Georgia, United States , 30341 ; vgc1@cdc.gov.
17
Kaiser Permanente Sacramento Medical Center, Sacramento, California, United States ; drvinson@ucdavis.edu.
18
Kaiser Permanente San Rafael Medical Center, 36623, San Rafael, California, United States ; dballard30@gmail.com.
19
University of California, Davis , Emergency Medicine, Sacramento, California, United States ; djtancredi@ucdavis.edu.
20
Kaiser Permanente Sacramento Medical Center, Sacramento, California, United States ; hxgarzon@gmail.com.
21
Kaiser Permanente South Sacramento Medical Center, 23542, Sacramento, California, United States ; drmackey@comcast.net.
22
University of California, Davis, Neurological Surgery , 4860 Y Street , Suite 3740 , Sacramento, California, United States , 95817 ; krshahlaie@ucdavis.edu.
23
University of California, Davis, Emergency Medicine, 95817, California, United States ; jfholmes@ucdavis.edu.

Abstract

Field triage guidelines recommend transport of head-injured patients on anticoagulants or antiplatelets to a higher-level trauma center based on studies suggesting a high incidence of traumatic intracranial hemorrhage (tICH). We compared the incidence of tICH in older adults transported by EMS with and without anticoagulation or antiplatelet use and evaluated the accuracies of different sets of field triage criteria to identify tICH. This was a prospective, observational study at 5 EMS agencies and 11 hospitals. Older adults (≥55 years) with head trauma and transported by EMS from Aug 2015 to Sept 2016 were eligible. EMS providers completed standardized data forms and patients were followed through ED or hospital discharge. We enrolled 1,304 patients; 1147 (88%) received a cranial CT scan and were eligible for analysis. 434 (33%) patients had anticoagulant or antiplatelet use and 112 (10%) had tICH. The incidence of tICH in patients with (11%, 95%CI 8-14%) and without (9%, 95%CI 7-11%) anticoagulant or antiplatelet use was similar. Anticoagulant or antiplatelet use was not predictive of tICH on adjusted analysis. Steps 1-3 criteria alone were not sensitive in identifying tICH (27%) while the addition of anticoagulant or antiplatelet criterion improved sensitivity (63%). Other derived sets of triage criteria were highly sensitive (>98%) but poorly specific (<11%). The incidence of tICH was similar between patients with and without anticoagulant or antiplatelet use. Use of anticoagulant or antiplatelet medications was not a risk factor for tICH. We were unable to identify a set of triage criteria that was accurate for trauma center need.

KEYWORDS:

GERIATRIC BRAIN INJURY; HEAD TRAUMA; TRAUMATIC BRAIN INJURY

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