• Matthew Miller, Richard Morris, Nicoletta Fisicaro, and Kate Curtis.
• Department of Anesthesia, Toronto Western Hospital, Toronto, Ontario, Canada.
• Emerg Med Australas. 2017 Oct 1; 29 (5): 563-569.

ObjectiveAnticoagulant and antiplatelet (ACAP) drugs are associated with increased mortality in trauma patients, therefore medication history on admission is important. Whether these medications are recorded on trauma admission has not been investigated, nor if absence of a medication history is associated with worse patient outcomes.MethodsWe conducted a retrospective database review combining demographic and outcome data from the St George Hospital (Sydney) trauma registry with admission medication history in the electronic record. To contrast medications with a known increased risk (ACAP) to patients with unknown risk, patients were divided into three groups: those on ACAPs, no-ACAP if medication history was present and no-ACAP documented, or no-Hx if no medication history recorded. Inclusion criteria were aged >16 and Injury Severity Score (ISS) >12. Admission demographic data and outcome data were compared between all three groups.ResultsOf 533 consecutive patients, 21% comprised the no-Hx group, while 22% were on an ACAP and 57% not on an ACAP. No-Hx patients had more severe head injuries and a younger median age compared to ACAP patients (42 vs 82 years old, P < 0.001). Mortality was higher for ACAP (24%; 95% CI 17-33%) compared to no-ACAP (11%; 95% CI 8-16%) or no-Hx patients (12%; 95% CI 7-20%) (P = 0.04).ConclusionsWhile a large number of severe trauma patients were admitted without a medication history, no-Hx patients did not appear at increased risk of adverse outcomes. ACAP patients had a higher mortality compared to no-ACAP highlighting the vulnerability of this group.© 2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

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