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

Abstract

BackgroundInjured 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. ObjectivesThe present study examined improvements in processes of care and triage accuracy when TTA criteria include an escalated response for older anticoagulated patients. MethodsA 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 < 0.001). Undertriage was reduced from 13% to 2% (p < 0.001). The trauma center significantly decreased time to first laboratory result, time to first computed tomography scan, and total time in ED prior to admission for A55 patients arriving from the scene of injury or by private vehicle. ConclusionCriteria that escalated the trauma response for A55 patients led to reductions in undertriage for anticoagulated older adults, as well as more timely mobilization of important clinical resources.