Geriatric Patients on Antithrombotic Agents who Fall: Does Trauma Team Activation Improve Outcomes?
| Autor: | Peter Hwang, Adrian W Ong, Anthony Martin, Amanda McNicholas, Alison Muller, Forrest B. Fernandez, Adam Sigal |
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| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Poison control 03 medical and health sciences 0302 clinical medicine Fibrinolytic Agents Trauma Centers Internal medicine Outcome Assessment Health Care 0502 economics and business medicine Humans Hospital Mortality Aged Retrospective Studies Aged 80 and over business.industry 05 social sciences Glasgow Coma Scale Anticoagulants 030208 emergency & critical care medicine Retrospective cohort study General Medicine Emergency department Odds ratio Quality Improvement Logistic Models Cohort Propensity score matching Accidental Falls Female 050211 marketing Triage Emergency Service Hospital business Fibrinolytic agent |
| Zdroj: | The American Surgeon. 85:721-724 |
| ISSN: | 1555-9823 0003-1348 |
| DOI: | 10.1177/000313481908500730 |
| Popis: | Despite the incorporation of anticoagulant and antiplatelet (ACAP) drugs in our trauma triage criteria, it is unclear whether trauma team activation (TTA) impacts outcomes in geriatric patients on ACAP drugs sustaining falls. We hypothesized that TTA in this cohort was associated with improved outcomes. The hospital electronic database was queried to identify normotensive, awake patients aged ≥65 years on ACAP agent from 2014 to 2018 presenting to the emergency department after falls. The outcome was in-hospital mortality. The association between TTA and mortality was examined using logistic regression analysis and 1:1 propensity score matching analysis. In this study, 4540 patients on ACAP drugs were analyzed, with TTA occurring in 500 (11%). TTA occurred in younger but more severely injured patients with lower Glasgow Coma Score. Logistic regression revealed that TTA was not associated with mortality (odds ratio [95% confidence intervals], 2.04 [0.89–4.25]). The 1:1 propensity score analysis revealed similar mortality for the matched groups (non-TTA, 1.6% vs TTA, 2.2%, P = 0.64). In the elderly patients on ACAP agents, the current triage criteria resulted in the appropriate use of TTA for more severely injured patients. The lack of outcome benefit suggests that ACAP drug use as a criterion for TTA should be re-evaluated. |
| Databáze: | OpenAIRE |
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