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

Daniel Nishijima, Samuel Gaona, Trent Waechter, Ric Maloney, Troy Bair, Adam Blitz, Andrew R. Elms, Roel D. Farrales, Calvin Howard, James Montoya, Jeneita M. Bell, Victor C. Coronado, David E. Sugerman, Dustin W. Ballard, Kevin E. Mackey, David R. Vinson, James F Holmes Jr

Research output: Contribution to journalArticle

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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 and 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.

Original languageEnglish (US)
Pages (from-to)1-7
Number of pages7
JournalPrehospital Emergency Care
DOIs
StateAccepted/In press - Sep 15 2016

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Craniocerebral Trauma
Anticoagulants
Hospital Emergency Service
Platelet Aggregation Inhibitors
Warfarin
Aspirin
clopidogrel
Traumatic Intracranial Hemorrhage
Penetrating Head Injuries
County Hospitals
Prisoners
Triage
Retrospective Studies
Guidelines

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency

Cite this

Do EMS Providers Accurately Ascertain Anticoagulant and Antiplatelet Use in Older Adults with Head Trauma? / Nishijima, Daniel; Gaona, Samuel; Waechter, Trent; Maloney, Ric; Bair, Troy; Blitz, Adam; Elms, Andrew R.; Farrales, Roel D.; Howard, Calvin; Montoya, James; Bell, Jeneita M.; Coronado, Victor C.; Sugerman, David E.; Ballard, Dustin W.; Mackey, Kevin E.; Vinson, David R.; Holmes Jr, James F.

In: Prehospital Emergency Care, 15.09.2016, p. 1-7.

Research output: Contribution to journalArticle

Nishijima, D, Gaona, S, Waechter, T, Maloney, R, Bair, T, Blitz, A, Elms, AR, Farrales, RD, Howard, C, Montoya, J, Bell, JM, Coronado, VC, Sugerman, DE, Ballard, DW, Mackey, KE, Vinson, DR & Holmes Jr, JF 2016, 'Do EMS Providers Accurately Ascertain Anticoagulant and Antiplatelet Use in Older Adults with Head Trauma?', Prehospital Emergency Care, pp. 1-7. https://doi.org/10.1080/10903127.2016.1218985
Nishijima, Daniel ; Gaona, Samuel ; Waechter, Trent ; Maloney, Ric ; Bair, Troy ; Blitz, Adam ; Elms, Andrew R. ; Farrales, Roel D. ; Howard, Calvin ; Montoya, James ; Bell, Jeneita M. ; Coronado, Victor C. ; Sugerman, David E. ; Ballard, Dustin W. ; Mackey, Kevin E. ; Vinson, David R. ; Holmes Jr, James F. / Do EMS Providers Accurately Ascertain Anticoagulant and Antiplatelet Use in Older Adults with Head Trauma?. In: Prehospital Emergency Care. 2016 ; pp. 1-7.
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title = "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 and 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.",
author = "Daniel Nishijima and Samuel Gaona and Trent Waechter and Ric Maloney and Troy Bair and Adam Blitz and Elms, {Andrew R.} and Farrales, {Roel D.} and Calvin Howard and James Montoya and Bell, {Jeneita M.} and Coronado, {Victor C.} and Sugerman, {David E.} and Ballard, {Dustin W.} and Mackey, {Kevin E.} and Vinson, {David R.} and {Holmes Jr}, {James F}",
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T1 - Do EMS Providers Accurately Ascertain Anticoagulant and Antiplatelet Use in Older Adults with Head Trauma?

AU - Nishijima, Daniel

AU - Gaona, Samuel

AU - Waechter, Trent

AU - Maloney, Ric

AU - Bair, Troy

AU - Blitz, Adam

AU - Elms, Andrew R.

AU - Farrales, Roel D.

AU - Howard, Calvin

AU - Montoya, James

AU - Bell, Jeneita M.

AU - Coronado, Victor C.

AU - Sugerman, David E.

AU - Ballard, Dustin W.

AU - Mackey, Kevin E.

AU - Vinson, David R.

AU - Holmes Jr, James F

PY - 2016/9/15

Y1 - 2016/9/15

N2 - 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 and 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.

AB - 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 and 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.

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