Presentation Details
| The anticoagulated trauma patient in the wilderness Emma DeLoughery, Thomas DeLoughery. Oregon Health & Science University, Portland, OR, USA |
Abstract
Background: Anticoagulants carry the natural risk of bleeding, leading many patients to have questions about activity limitations, particularly recreational or wilderness activities. Although it would seem that such patients would be at higher risk for poor outcome there is little data to support this theory. Therefore, this study used data from the National Trauma Data Bank (NTDB), which provides trauma registry data from a variety of trauma centers around the United States, to analyze outcomes in the anticoagulated patient in the wilderness as compared to both their non-anticoagulated counterpart as well as the anticoagulated patient not in the wilderness.
Methods: Data was obtained from the NTDB. Cohorts were identified by a ‘yes’ to the comorbidity of anticoagulant therapy with the trauma taking place in a wilderness/recreational setting as defined by ICD-10 codes. Two separate groups were identified – one with controls composed of non-anticoagulated patients injured in a recreational/wilderness setting (A), and one with controls of anticoagulated patients injured in a non-recreational/wilderness setting (B). Both control groups were matched on age, sex, injury severity score (ISS), and several comorbidities. Outcome measures included emergency department (ED) and hospital disposition and length of stay.
Results: A total of 6411 anticoagulated trauma patients in the wilderness were found, along with 3152 in each A group and 3026 in each B group (Table 1). Cohort A had a lower ED mortality (0.1% cohort vs 0.3% control, P = 0.03) (Table 2). There was no difference in length of stay (4.9 vs 4.8 days, P = 0.4). There was no difference in hospital mortality (1.3% vs 1.1%, P = 0.38), discharge home from the hospital among survivors (73.1% vs 75.0%, P = 0.06), or discharge home from the ED (10.3% vs 9.0%, P = 0.09). Control B had increased ED mortality (0.1% vs 0.5%, P = 0.01) and increased hospital mortality (1.8% vs 5.1%, P <0.001). Cohort B had a shorter length of stay (5.0 vs 5.5 days, P <0.001). Cohort B had a higher rate of discharge home from the hospital (67.2% vs 52.6%, P <0.001). There was no difference in discharge home from the ED (10.1% vs 11.4%, P = 0.1).
Conclusions: This study showed similar mortality rates among anticoagulated and non-anticoagulated trauma patients in the wilderness, and lower mortality in anticoagulated patients in the wilderness compared with anticoagulated patients in other settings. Despite efforts to match for comorbidities, anticoagulated patients in the wilderness may be healthier than their non-wilderness counterparts. Limitations include use of registry data that may be incomplete, limited data availability, particularly in regards to transfusion and lab data, as well as inability to identify specific anticoagulants and possibility of inclusion of patients on anti-platelets as well as those not on anticoagulants but with bleeding disorders. Additionally, patients taking anticoagulants may avoid situations where injury is likely to occur. This study suggests that persons on anticoagulation are not at higher risk of mortality when engaging in wilderness or recreational activities though further studies are needed in this population to help better inform risk.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.
Methods: Data was obtained from the NTDB. Cohorts were identified by a ‘yes’ to the comorbidity of anticoagulant therapy with the trauma taking place in a wilderness/recreational setting as defined by ICD-10 codes. Two separate groups were identified – one with controls composed of non-anticoagulated patients injured in a recreational/wilderness setting (A), and one with controls of anticoagulated patients injured in a non-recreational/wilderness setting (B). Both control groups were matched on age, sex, injury severity score (ISS), and several comorbidities. Outcome measures included emergency department (ED) and hospital disposition and length of stay.
Results: A total of 6411 anticoagulated trauma patients in the wilderness were found, along with 3152 in each A group and 3026 in each B group (Table 1). Cohort A had a lower ED mortality (0.1% cohort vs 0.3% control, P = 0.03) (Table 2). There was no difference in length of stay (4.9 vs 4.8 days, P = 0.4). There was no difference in hospital mortality (1.3% vs 1.1%, P = 0.38), discharge home from the hospital among survivors (73.1% vs 75.0%, P = 0.06), or discharge home from the ED (10.3% vs 9.0%, P = 0.09). Control B had increased ED mortality (0.1% vs 0.5%, P = 0.01) and increased hospital mortality (1.8% vs 5.1%, P <0.001). Cohort B had a shorter length of stay (5.0 vs 5.5 days, P <0.001). Cohort B had a higher rate of discharge home from the hospital (67.2% vs 52.6%, P <0.001). There was no difference in discharge home from the ED (10.1% vs 11.4%, P = 0.1).
Conclusions: This study showed similar mortality rates among anticoagulated and non-anticoagulated trauma patients in the wilderness, and lower mortality in anticoagulated patients in the wilderness compared with anticoagulated patients in other settings. Despite efforts to match for comorbidities, anticoagulated patients in the wilderness may be healthier than their non-wilderness counterparts. Limitations include use of registry data that may be incomplete, limited data availability, particularly in regards to transfusion and lab data, as well as inability to identify specific anticoagulants and possibility of inclusion of patients on anti-platelets as well as those not on anticoagulants but with bleeding disorders. Additionally, patients taking anticoagulants may avoid situations where injury is likely to occur. This study suggests that persons on anticoagulation are not at higher risk of mortality when engaging in wilderness or recreational activities though further studies are needed in this population to help better inform risk.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.