Citation

Callahan ZM, Gadomski SP, Koganti D, Patel PH, Beekley AC, Williams P, Donnelly J, Cohen MJ, Marks JA. Am. J. Surg. 2019; ePub(ePub): ePub.

Affiliation

Division of Trauma and Acute Care Surgery, Department of Surgery, Thomas Jefferson University Hospital, 1015 Walnut St, Curtis Building Suite 620, Philadelphia, PA, 19107, USA. Electronic address: Joshua.Marks@jefferson.edu.

Copyright

(Copyright © 2019, Elsevier Publishing)

DOI

10.1016/j.amjsurg.2019.04.011

PMID

31030991

Abstract

BACKGROUND: Our institution amended its trauma activation criteria to require a Level II activation for patients ≥65 years old on antithrombotic medication presenting with suspected head trauma.

METHODS: Our institutional trauma registry was queried for geriatric patients on antithrombotic medication in the year before and after this criteria change. Demographics, presentation metrics, level of activation, and outcomes were compared between groups.

RESULTS: After policy change, a greater proportion of patients received a trauma activation (19.9 vs. 74.9%, P < 0.001) and a greater proportion of these patients were discharged directly home without injury (4.3 vs. 44%, P < 0.001). However, a smaller proportion of patients with a critical Emergency Department disposition or traumatic intracranial hemorrhage failed to receive a trauma activation (65.1 vs. 23.5%, P < 0.001; 70.7% vs. 27.3%, P < 0.001). There was no change in mortality (4.3 vs. 2.0%, P = 0.21).

CONCLUSIONS: Implementing new criteria increased overtriage, decreased undertriage, and had little effect on mortality.

Copyright © 2019 Elsevier Inc. All rights reserved.

Language: en

Keywords

Anticoagulation; Antithrombotic; Geriatric trauma; Overtriage; Triage; Undertriage