Hwang Peter, Ong Adrian W, Muller Alison, McNicholas Amanda, Martin Anthony, Sigal Adam, Fernandez Forrest B
Am Surg. 2019 Jul 1;85(7):721-724.
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% TTA, 2.2%, = 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.
尽管我们在创伤分诊标准中纳入了抗凝和抗血小板（ACAP）药物，但尚不清楚创伤团队启动（TTA）对服用ACAP药物且持续跌倒的老年患者的预后是否有影响。我们假设该队列中的TTA与改善的预后相关。查询医院电子数据库，以识别2014年至2018年期间年龄≥65岁、服用ACAP药物、跌倒后前往急诊科的血压正常、清醒的患者。结局指标为院内死亡率。使用逻辑回归分析和1:1倾向评分匹配分析来检验TTA与死亡率之间的关联。在本研究中，对4540例服用ACAP药物的患者进行了分析，其中500例（11%）发生了TTA。TTA发生在年龄较轻但受伤更严重、格拉斯哥昏迷评分较低的患者中。逻辑回归显示，TTA与死亡率无关（比值比[95%置信区间]，2.04[0.89 - 4.25]）。1:1倾向评分分析显示匹配组的死亡率相似（非TTA组为1.6%，TTA组为2.2%，P = 0.64）。在服用ACAP药物的老年患者中，当前的分诊标准导致对受伤更严重的患者适当使用了TTA。缺乏预后益处表明，应重新评估将ACAP药物使用作为TTA标准的做法。
