Field Triage of Older Adults Who Experience Traumatic Brain Injury

对遭受脑外伤的老年人进行现场分诊

• 批准号: 8536586
• 负责人: MANISH N SHAH
• 金额: $ 24.93万
• 依托单位: UNIVERSITY OF ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-30 至 2015-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8536586
• 关键词: Field; Triage; Older; Adults; Who

DESCRIPTION (provided by applicant): Abstract Traumatic brain injury (TBI) is major source of disability and death for older adults. Of particular concern is that older adults most frequentl sustain TBIs after low-mechanism injuries, such as falls from standing height, and frequently use anticoagulants and platelet inhibitors, which place them at risk for worse clinical outcomes. With the growth of the older adult population and the expanding use of anticoagulants and platelet inhibitors, TBI among older adults will continue to be a major source of morbidity and mortality unless methods are identified to improve outcomes in this unique population. Our overall goal in this proposed study is to describe the current prehospital trauma triage process for older adult (agee55) patients with suspected TBI, to identify the effect of anticoagulants and platelet inhibitors on TBI-related need for trauma center services, and to identify novel TBI screening strategies that are feasible for use in the prehospital setting. We will build upon our long-standing and highly successful EMS research laboratory that has specifically focused on the triage of injured patients and the prehospital care of older patients. We will employ a combination of qualitative and quantitative methods, collecting data from a large, multi-county catchment area that includes multiple EMS agencies, urban and rural environments, as well as trauma centers and non-trauma centers. In this study, we will: 1) identify candidate neurologic scales to maximize detection of high-risk older adult TBI patients; 2) characterize the current trauma triage process used by EMS providers to identify older patients with suspected TBI and patients taking anticoagulants and/or platelet inhibitors; 3) assess the public health burden of TBI among older adult EMS patients taking anticoagulants and/or platelet inhibitors; 4) assess the predictive ability of novel prehospital-based neurologic screening strategies to identify high-risk older adult TBI patients in the prehospital setting who require TBI- related trauma center care. Findings from this study have the potential to shift clinical practice in the prehospital setting by informing future recommendations for the identification of TBI among older adults taking anticoagulants or platelet inhibitors.

描述（由申请人提供）：摘要创伤性脑损伤（TBI）是老年人残疾和死亡的主要原因。特别值得关注的是，老年人最常在低机制损伤（例如从站立高度跌落）后遭受创伤性脑损伤，并且经常使用抗凝剂和血小板抑制剂，这使他们面临更糟糕的临床结果的风险。随着老年人口的增长以及抗凝剂和血小板抑制剂的广泛使用，除非找到改善这一独特人群预后的方法，否则老年人中的 TBI 将继续成为发病率和死亡率的主要来源。我们在这项拟议研究中的总体目标是描述目前疑似 TBI 的老年 (agee55) 患者的院前创伤分诊流程，确定抗凝剂和血小板抑制剂对 TBI 相关创伤中心服务需求的影响，并确定新的治疗方法。适用于院前环境的 TBI 筛查策略。我们将建立在我们长期且非常成功的 EMS 研究实验室的基础上，该实验室专门专注于受伤患者的分类和老年患者的院前护理。我们将采用定性和定量相结合的方法，从大型、多县的服务区域收集数据，其中包括多个 EMS 机构、城市和农村环境以及创伤中心和非创伤中心。在本研究中，我们将：1）确定候选神经系统量表，以最大限度地检测高危老年 TBI 患者； 2) 描述 EMS 提供者当前使用的创伤分诊流程，以识别疑似 TBI 的老年患者以及服用抗凝剂和/或血小板抑制剂的患者； 3) 评估服用抗凝剂和/或血小板抑制剂的老年 EMS 患者中 TBI 的公共卫生负担； 4) 评估基于院前的新型神经系统筛查策略的预测能力，以识别院前环境中需要 TBI 相关创伤中心护理的高危老年 TBI 患者。这项研究的结果有可能改变院前环境中的临床实践，为未来在服用抗凝剂或血小板抑制剂的老年人中识别 TBI 提供建议。