• Daniel K Nishijima, Samuel D Gaona, Trent Waechter, Ric Maloney, Adam Blitz, Andrew R Elms, Roel D Farrales, James Montoya, Troy Bair, Calvin Howard, Megan Gilbert, Renee P Trajano, Kaela M Hatchel, Mark Faul, Jeneita M Bell, Victor C Coronado, David R Vinson, Dustin W Ballard, Daniel J Tancredi, Hernando Garzon, Kevin E Mackey, Kiarash Shahlaie, and James F Holmes.
• Department of Emergency Medicine, UC Davis School of Medicine, Sacramento, California.
• J. Neurotrauma. 2018 Mar 1; 35 (5): 750-759.

AbstractField triage guidelines recommend transport of head-injured patients on anticoagulants or antiplatelets to a higher-level trauma center based on studies suggesting a high incidence of traumatic intracranial hemorrhage (tICH). We compared the incidence of tICH in older adults transported by emergency medical services (EMS) with and without anticoagulation or antiplatelet use and evaluated the accuracies of different sets of field triage criteria to identify tICH. This was a prospective, observational study at five EMS agencies and 11 hospitals. Older adults (≥55 years) with head trauma and transported by EMS from August 2015 to September 2016 were eligible. EMS providers completed standardized data forms and patients were followed through emergency department (ED) or hospital discharge. We enrolled 1304 patients; 1147 (88%) received a cranial computed tomography (CT) scan and were eligible for analysis. Four hundred thirty-four (33%) patients had anticoagulant or antiplatelet use and 112 (10%) had tICH. The incidence of tICH in patients with (11%, 95% confidence interval [CI] 8%-14%) and without (9%, 95% CI 7%-11%) anticoagulant or antiplatelet use was similar. Anticoagulant or antiplatelet use was not predictive of tICH on adjusted analysis. Steps 1-3 criteria alone were not sensitive in identifying tICH (27%), whereas the addition of anticoagulant or antiplatelet criterion improved sensitivity (63%). Other derived sets of triage criteria were highly sensitive (>98%) but poorly specific (<11%). The incidence of tICH was similar between patients with and without anticoagulant or antiplatelet use. Use of anticoagulant or antiplatelet medications was not a risk factor for tICH. We were unable to identify a set of triage criteria that was accurate for trauma center need.

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