Geriatric Patients on Antithrombotic Agents Who Fall: Does Trauma Team Activation Improve Outcomes? PETER HWANG, D.O.,* ADRIAN W. ONG, M.D.,† ALISON MULLER, M.L.S. (A.S.C.P.), M.S.P.H.,† AMANDA MCNICHOLAS, C.R.N.P., D.N.P.,†ANTHONY MARTIN, B.S.N.,† ADAM SIGAL, M.D.,‡ FORREST B. FERNANDEZ, M.D.† From the *Department of Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia Pennsylvania; †Department of Surgery, Reading Hospital, Tower Health System, Reading, Pennsylvania; and ‡Department of Emergency Medicine, Reading Hospital, Tower Health System, Reading, Pennsylvania Despite the incorporation of anticoagulant and antiplatelet (ACAP) drugs in our trauma triage criteria, it is unclear whether trauma team activation (TTA) impacts outcomes in geriatric patients on ACAP drugs sustaining falls. We hypothesized that TTA in this cohort was associated with improved outcomes. The hospital electronic database was queried to identify normotensive, awake patients aged ‡65 years on ACAP agent from 2014 to 2018 presenting to the emergency department after falls. The outcome was in-hospital mortality. The association between TTA and mortality was examined using logistic regression analysis and 1:1 propensity score matching analysis. In this study, 4540 patients on ACAP drugs were analyzed, with TTA occurring in 500 (11%). TTA occurred in younger but more severely injured patients with lower Glasgow Coma Score. Logistic regression revealed that TTA was not associated with mortality (odds ratio [95% confidence intervals], 2.04 [0.89–4.25]). The 1:1 propensity score analysis revealed similar mortality for the matched groups (non-TTA, 1.6% vs TTA, 2.2%, P 5 0.64). In the elderly patients on ACAP agents, the current triage criteria resulted in the appropriate use of TTA for more severely injured patients. The lack of outcome benefit suggests that ACAP drug use as a criterion for TTA should be re-evaluated. F ALLS ARE A common low-energy mechanism of traumatic injury, especially in the elderly pop- ulation, and are associated with significant morbidity and mortality. 1–3 In the elderly patients, several studies have suggested unfavorable outcomes associated with preinjury use of anticoagulant and antiplatelet (ACAP) agents, particularly in the setting of traumatic brain injuries. 4, 5 Our institution had incorporated the use of ACAP agents in the trauma team activation (TTA) criteria for geriatric patients sustaining falls. It was felt that early detection of potentially devastating hemor- rhagic injuries in this vulnerable cohort could improve trauma-related outcomes. We aimed to evaluate whether TTA was associated with improved outcomes in awake, hemodynamically stable geriatric patients on ACAP agents. We hypothesized that in this cohort, TTA was associated with improved mortality. Methods A retrospective study was performed using the hospital electronic database from January 1, 2014, to March 1, 2018, of all patients aged $65 years on ACAP agents presenting to the emergency department after falls. We excluded patients transferred from an- other hospital and patients with concomitant pene- trating trauma, injury time $48 hours to presentation, intubation before arrival, Glasgow Coma Score (GCS) of #13, admission systolic blood pressure (SBP) of <100 mmHg, or heart rate (HR) >120 bpm or <50 bpm. The trauma triage criteria are as shown in Figure 1. The three-tiered system was divided into “trauma alert” (the highest level), “trauma response,” and “Tier 3.” The first two levels of activation involved the trauma team. For Tier 3 activations, patients were evaluated by the emergency medicine physician without any trauma team involvement. We excluded patients who underwent “trauma alert,” as these Presented as a Podium paper at the Southeastern Surgical Congress 2019 Annual Scientific Meeting, February 23–26, 2019, Charlotte, NC. Address correspondence and reprint requests to Adrian W. Ong, M.D., Department of Surgery, Reading Hospital, Tower Health System, 420 S, 5th Avenue, Reading, PA 19611. E-mail: Adrian. ong@towerhealth.org. 721