Comparison of Risk Factors and Outcomes for Blunt Trauma Patients on Anticoagulants or Antiplatelet Agents Evaluated in Urban and Suburban Settings.
Annals of Emergency Medicine
Study ObjectiveIn the United States, there has been an increase in anticoagulation or anti-platelet agents in the geriatric population. This demographic is also at risk for falls or other blunt trauma, resulting in significant post-injury bleeding. The best management strategy for anti-platelet-related bleeding is still under debate. Preliminary data suggest that the incidence of clinically significant intracranial hemorrhage is significantly lower with NOAC/DOACs than with anti-Vitamin K anticoagulants. Nonetheless, the risk of bleeding is still present. Our objective was to compare the outcomes of patients evaluated for blunt trauma on anticoagulant or antiplatelet agents.
MethodsResearch assistants prospectively collected data at two institutions, William Beaumont Hospital (WBH) and Henry Ford Hospital HFH) from September 2018 to February 2020. Each institution has a different pattern for evaluating patients who have sustained blunt trauma while receiving treatment with an anticoagulant or an anti-platelet agent, or both. Currently, HFH has a required minimum observation period for patients with blunt trauma while receiving anticoagulants, whereas WBH does not.
ResultsA total of 643 patients were included in the study – 411 (64%) from HFH and 232 (36%) from WB. Patients at HFH are younger (71 v. 74; p=0.001), more likely to be African American (65% v. 20%; p<.001), and have a lower SBP (141 v. 148; p=0.004) than patients at WBH. There was a higher proportion of head CTs ordered at WBH than HFH (72% v. 53%; p<.001). However, the head CT findings were not significantly different between sites. 1.7% of the subjects at WBH had CT scans positive for ICH, while 4% of the subjects at HFH had CT scans positive for ICH. The proportion of patients admitted did not differ, but the ED LOS did vary across sites. On average, patients admitted to HFH ED stayed longer than patients admitted to WBH ED (4.91 hours v. 3.95 hours; p=0.026). The proportion of FAST exams ordered was higher for WBH hospital (5% v. 3%; p<.001). However, HFH saw a higher proportion of positive FAST exams (27% v. 0%; p=0.005). WBH had a higher proportion of patients whose mechanism was a mechanical fall than HFH (90% v. 82%; p=0.048). Other mechanisms of injury included MVC (8%) and Syncope (16%). HFH had a higher proportion of patients on calcium channel blocker than WBH (29% v. 20%; p=0.015).
ConclusionDespite more frequent head CT imaging at the suburban site there was no statistical difference in the frequency of intracranial pathology. Additionally, despite a longer ED LOS for patients at the urban site there was no statistical difference in the proportion of patients admitted. Further studies will evaluate the nature of the need for admissions and whether the type of anticoagulant or antiplatelet agent was associated with a greater frequency of pathology.
Beyer M, Littman H, Stokes-Buzzelli S, Miller J, Otero R, Klausner H. Comparison of risk factors and outcomes for blunt trauma patients on anticoagulants or antiplatelet agents evaluated in urban and suburban settings. Ann Emerg Med. 2021 Oct;78(4 suppl.):S12.