title: Do EMS Providers Accurately Ascertain Anticoagulant and Antiplatelet Use in Older Adults with Head Trauma?
abstract: Prehospital provider assessment of the use of anticoagulant or antiplatelet medications in older adults with head trauma is important. These patients are at increased risk for traumatic intracranial hemorrhage and therefore field triage guidelines recommend transporting these patients to centers capable of rapid evaluation and treatment. Our objective was to evaluate EMS ascertainment of anticoagulant and antiplatelet medication use in older adults with head trauma.
  
  
  
  A retrospective study of older adults with head trauma was conducted throughout Sacramento County. All 5 transporting EMS agencies and all 11 hospitals in the county were included in the study, which ran from January 2012 to December 2012. Patients ≥55 years who were transported to a hospital by EMS after head trauma were included. We excluded patients transferred between two facilities, patients with penetrating head trauma, prisoners, and patients with unmatched hospital data. Anticoagulant and antiplatelet use were categorized as: warfarin, direct oral anticoagulants (DOAC; dabigatran, rivaroxaban, and apixaban), aspirin, and other antiplatelet agents (e.g., clopidogrel and ticagrelor). We calculated the percent agreement and kappa statistic for binary variables between EMS and emergency department (ED)/hospital providers. A kappa statistic ≥0.60 was considered acceptable agreement.
  
  
  
  After excluding 174 (7.6%) patients, 2,110 patients were included for analysis; median age was 73 years (interquartile range 62-85 years) and 1,259 (60%) were male. Per ED/hospital providers, the use of any anticoagulant or antiplatelet agent was identified in 595 (28.2%) patients. Kappa statistics between EMS and ED/hospital providers for the specific agents were: 0.76 (95% CI 0.71-0.82) for warfarin, 0.45 (95% CI 0.19-0.71) for DOAC agents, 0.33 (95% CI 0.28-0.39) for aspirin, and 0.51 (95% CI 0.42-0.60) for other antiplatelet agents.
  
  
  
  The use of antiplatelet or anticoagulant medications in older adults who are transported by EMS for head trauma is common. EMS and ED/hospital providers have acceptable agreement with preinjury warfarin use but not with DOAC, aspirin, and other antiplatelet use.
authors.forename: Daniel K
authors.initials: DK
authors.lastname: Nishijima
authors.forename: Samuel
authors.initials: S
authors.lastname: Gaona
authors.forename: Trent
authors.initials: T
authors.lastname: Waechter
authors.forename: Ric
authors.initials: R
authors.lastname: Maloney
authors.forename: Troy
authors.initials: T
authors.lastname: Bair
authors.forename: Adam
authors.initials: A
authors.lastname: Blitz
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Elms
authors.forename: Roel D
authors.initials: RD
authors.lastname: Farrales
authors.forename: Calvin
authors.initials: C
authors.lastname: Howard
authors.forename: James
authors.initials: J
authors.lastname: Montoya
authors.forename: Jeneita M
authors.initials: JM
authors.lastname: Bell
authors.forename: Victor C
authors.initials: VC
authors.lastname: Coronado
authors.forename: David E
authors.initials: DE
authors.lastname: Sugerman
authors.forename: Dustin W
authors.initials: DW
authors.lastname: Ballard
authors.forename: Kevin E
authors.initials: KE
authors.lastname: Mackey
authors.forename: David R
authors.initials: DR
authors.lastname: Vinson
authors.forename: James F
authors.initials: JF
authors.lastname: Holmes
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D006259:Craniocerebral Trauma / Q000150:complications; D004632:Emergency Medical Services / Q000592:standards; D005260:Female; D006801:Humans; D020198:Intracranial Hemorrhage, Traumatic / Q000209:etiology / Q000628:therapy*; D008297:Male; D008487:Medical History Taking / Q000592:standards*; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D012189:Retrospective Studies; D014218:Triage / Q000592:standards*; D014481:United States
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors
keywords: Emergency Medical Services; anticoagulants; head injuries, closed; medication reconciliation; platelet aggregation inhibitors