Preinjury Warfarin Does Not Impact Outcome in Trauma Patients
OBJECTIVE The objective of this study was to determine whether the preinjury condition of anticoagulation had an adverse impact on patients sustaining injury. METHODS A retrospective analysis was performed for prospectively collected registry data from 1995–2000 from all accredited trauma centers in...
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| Veröffentlicht in: | The journal of trauma 2001-12, Vol.51 (6), p.1147-1152 |
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| container_title | The journal of trauma |
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| creator | Wojcik, Randolph Cipolle, Mark D. Seislove, Elizabeth Wasser, Thomas E. Pasquale, Michael D. |
| description | OBJECTIVE The objective of this study was to determine whether the preinjury condition of anticoagulation had an adverse impact on patients sustaining injury.
METHODS A retrospective analysis was performed for prospectively collected registry data from 1995–2000 from all accredited trauma centers in Pennsylvania. The registry was queried for all trauma patients who had anticoagulation therapy as a preinjury condition (PIC). This group served as our experimental cohort. A control cohort (not having warfarin therapy as a PIC) was developed using case-matching techniques for age, sex, Glasgow Coma Scale (GCS), Injury Severity Score (ISS), A Severity Characterization of Trauma (ASCOT) score, and in the head injured patients, International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnoses. Head and non-head injured patients were evaluated separately. The cohorts were examined for 28-day mortality, intensive care unit length of stay (ICU-LOS), hospital length of stay (HOS-LOS), PICs, occurrences, discharge destinations, and functional status at discharge. χ and Student’s t test were used to evaluate the data;p values < 0.05 were considered significant.
RESULTS Two thousand nine hundred forty-two patients were available for analysis. The prevalence of PICs was significantly greater in the warfarin group for both the head and non-head injured populations (p < 0.003 and p < 0.0001, respectively). The incidence of occurrences in the non-head injured population was statistically higher for the warfarin patients (p < 0.001), but showed no difference in the head injured group regardless of warfarin use (p = 0.15). Functional status at discharge demonstrated no clinically significant difference between the warfarin and non-warfarin groups in both head and non-head injured populations. There was no difference in discharge destination in the head injured population; however, in the non-head injured population a greater percentage of non-warfarin patients was discharged to home when compared with the warfarin patients.
CONCLUSION Our data suggest that the PIC of anticoagulation with warfarin does not adversely impact mortality or LOS outcomes in both head and non-head injured patients. In non-head injured patients, however, the occurrence rates and discharge destination were different. More research needs to be done to determine whether this is related to anticoagulation or other reasons (i.e., number of PICs). These data should be used |
| doi_str_mv | 10.1097/00005373-200112000-00021 |
| format | Article |
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METHODS A retrospective analysis was performed for prospectively collected registry data from 1995–2000 from all accredited trauma centers in Pennsylvania. The registry was queried for all trauma patients who had anticoagulation therapy as a preinjury condition (PIC). This group served as our experimental cohort. A control cohort (not having warfarin therapy as a PIC) was developed using case-matching techniques for age, sex, Glasgow Coma Scale (GCS), Injury Severity Score (ISS), A Severity Characterization of Trauma (ASCOT) score, and in the head injured patients, International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnoses. Head and non-head injured patients were evaluated separately. The cohorts were examined for 28-day mortality, intensive care unit length of stay (ICU-LOS), hospital length of stay (HOS-LOS), PICs, occurrences, discharge destinations, and functional status at discharge. χ and Student’s t test were used to evaluate the data;p values < 0.05 were considered significant.
RESULTS Two thousand nine hundred forty-two patients were available for analysis. The prevalence of PICs was significantly greater in the warfarin group for both the head and non-head injured populations (p < 0.003 and p < 0.0001, respectively). The incidence of occurrences in the non-head injured population was statistically higher for the warfarin patients (p < 0.001), but showed no difference in the head injured group regardless of warfarin use (p = 0.15). Functional status at discharge demonstrated no clinically significant difference between the warfarin and non-warfarin groups in both head and non-head injured populations. There was no difference in discharge destination in the head injured population; however, in the non-head injured population a greater percentage of non-warfarin patients was discharged to home when compared with the warfarin patients.
CONCLUSION Our data suggest that the PIC of anticoagulation with warfarin does not adversely impact mortality or LOS outcomes in both head and non-head injured patients. In non-head injured patients, however, the occurrence rates and discharge destination were different. More research needs to be done to determine whether this is related to anticoagulation or other reasons (i.e., number of PICs). These data should be used when weighing risk/benefit ratios of prescribing chronic anticoagulation.</description><identifier>ISSN: 0022-5282</identifier><identifier>EISSN: 1529-8809</identifier><identifier>DOI: 10.1097/00005373-200112000-00021</identifier><identifier>PMID: 11740267</identifier><language>eng</language><publisher>United States: Lippincott Williams & Wilkins, Inc</publisher><subject>Aged ; Anticoagulants - adverse effects ; Case-Control Studies ; Cohort Studies ; Craniocerebral Trauma - etiology ; Craniocerebral Trauma - mortality ; Female ; Humans ; Injury Severity Score ; Length of Stay ; Male ; Patient Discharge ; Pennsylvania - epidemiology ; Prospective Studies ; Registries ; Retrospective Studies ; Trauma Centers ; Warfarin - adverse effects ; Wounds and Injuries - etiology ; Wounds and Injuries - mortality</subject><ispartof>The journal of trauma, 2001-12, Vol.51 (6), p.1147-1152</ispartof><rights>2001 Lippincott Williams & Wilkins, Inc.</rights><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3561-b9ace4cdc2610c7dbf2df4e15a6db33564927acbd0b499f8181c3574256ca2853</citedby><cites>FETCH-LOGICAL-c3561-b9ace4cdc2610c7dbf2df4e15a6db33564927acbd0b499f8181c3574256ca2853</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/11740267$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Wojcik, Randolph</creatorcontrib><creatorcontrib>Cipolle, Mark D.</creatorcontrib><creatorcontrib>Seislove, Elizabeth</creatorcontrib><creatorcontrib>Wasser, Thomas E.</creatorcontrib><creatorcontrib>Pasquale, Michael D.</creatorcontrib><title>Preinjury Warfarin Does Not Impact Outcome in Trauma Patients</title><title>The journal of trauma</title><addtitle>J Trauma</addtitle><description>OBJECTIVE The objective of this study was to determine whether the preinjury condition of anticoagulation had an adverse impact on patients sustaining injury.
METHODS A retrospective analysis was performed for prospectively collected registry data from 1995–2000 from all accredited trauma centers in Pennsylvania. The registry was queried for all trauma patients who had anticoagulation therapy as a preinjury condition (PIC). This group served as our experimental cohort. A control cohort (not having warfarin therapy as a PIC) was developed using case-matching techniques for age, sex, Glasgow Coma Scale (GCS), Injury Severity Score (ISS), A Severity Characterization of Trauma (ASCOT) score, and in the head injured patients, International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnoses. Head and non-head injured patients were evaluated separately. The cohorts were examined for 28-day mortality, intensive care unit length of stay (ICU-LOS), hospital length of stay (HOS-LOS), PICs, occurrences, discharge destinations, and functional status at discharge. χ and Student’s t test were used to evaluate the data;p values < 0.05 were considered significant.
RESULTS Two thousand nine hundred forty-two patients were available for analysis. The prevalence of PICs was significantly greater in the warfarin group for both the head and non-head injured populations (p < 0.003 and p < 0.0001, respectively). The incidence of occurrences in the non-head injured population was statistically higher for the warfarin patients (p < 0.001), but showed no difference in the head injured group regardless of warfarin use (p = 0.15). Functional status at discharge demonstrated no clinically significant difference between the warfarin and non-warfarin groups in both head and non-head injured populations. There was no difference in discharge destination in the head injured population; however, in the non-head injured population a greater percentage of non-warfarin patients was discharged to home when compared with the warfarin patients.
CONCLUSION Our data suggest that the PIC of anticoagulation with warfarin does not adversely impact mortality or LOS outcomes in both head and non-head injured patients. In non-head injured patients, however, the occurrence rates and discharge destination were different. More research needs to be done to determine whether this is related to anticoagulation or other reasons (i.e., number of PICs). These data should be used when weighing risk/benefit ratios of prescribing chronic anticoagulation.</description><subject>Aged</subject><subject>Anticoagulants - adverse effects</subject><subject>Case-Control Studies</subject><subject>Cohort Studies</subject><subject>Craniocerebral Trauma - etiology</subject><subject>Craniocerebral Trauma - mortality</subject><subject>Female</subject><subject>Humans</subject><subject>Injury Severity Score</subject><subject>Length of Stay</subject><subject>Male</subject><subject>Patient Discharge</subject><subject>Pennsylvania - epidemiology</subject><subject>Prospective Studies</subject><subject>Registries</subject><subject>Retrospective Studies</subject><subject>Trauma Centers</subject><subject>Warfarin - adverse effects</subject><subject>Wounds and Injuries - etiology</subject><subject>Wounds and Injuries - mortality</subject><issn>0022-5282</issn><issn>1529-8809</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2001</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kMtOwzAQRS0EoqXwC8g_YPAzthcsUHlVqmgXRSwtx3HUlKSp7ERV_x5DCqywNB5p5p5ZHAAgwTcEa3mL0xNMMkQxJiR9GKWi5ASMiaAaKYX1KRinEUWCKjoCFzFuUoRzps7BiBDJMc3kGNwtg6-2mz4c4LsNpQ3VFj60PsLXtoOzZmddBxd959rGw7RaBds3Fi5tV_ltFy_BWWnr6K-OfQLenh5X0xc0XzzPpvdz5JjICMq1dZ67wtGMYCeLvKRFyT0RNityliJcU2ldXuCca10qokgCJacic5YqwSZADXddaGMMvjS7UDU2HAzB5suI-TFifo2YbyMJvR7QXZ83vvgDjwpSgA-BfVt3PsSPut_7YNbe1t3a_GeafQIDjWpg</recordid><startdate>200112</startdate><enddate>200112</enddate><creator>Wojcik, Randolph</creator><creator>Cipolle, Mark D.</creator><creator>Seislove, Elizabeth</creator><creator>Wasser, Thomas E.</creator><creator>Pasquale, Michael D.</creator><general>Lippincott Williams & Wilkins, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope></search><sort><creationdate>200112</creationdate><title>Preinjury Warfarin Does Not Impact Outcome in Trauma Patients</title><author>Wojcik, Randolph ; Cipolle, Mark D. ; Seislove, Elizabeth ; Wasser, Thomas E. ; Pasquale, Michael D.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3561-b9ace4cdc2610c7dbf2df4e15a6db33564927acbd0b499f8181c3574256ca2853</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2001</creationdate><topic>Aged</topic><topic>Anticoagulants - adverse effects</topic><topic>Case-Control Studies</topic><topic>Cohort Studies</topic><topic>Craniocerebral Trauma - etiology</topic><topic>Craniocerebral Trauma - mortality</topic><topic>Female</topic><topic>Humans</topic><topic>Injury Severity Score</topic><topic>Length of Stay</topic><topic>Male</topic><topic>Patient Discharge</topic><topic>Pennsylvania - epidemiology</topic><topic>Prospective Studies</topic><topic>Registries</topic><topic>Retrospective Studies</topic><topic>Trauma Centers</topic><topic>Warfarin - adverse effects</topic><topic>Wounds and Injuries - etiology</topic><topic>Wounds and Injuries - mortality</topic><toplevel>online_resources</toplevel><creatorcontrib>Wojcik, Randolph</creatorcontrib><creatorcontrib>Cipolle, Mark D.</creatorcontrib><creatorcontrib>Seislove, Elizabeth</creatorcontrib><creatorcontrib>Wasser, Thomas E.</creatorcontrib><creatorcontrib>Pasquale, Michael D.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><jtitle>The journal of trauma</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wojcik, Randolph</au><au>Cipolle, Mark D.</au><au>Seislove, Elizabeth</au><au>Wasser, Thomas E.</au><au>Pasquale, Michael D.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Preinjury Warfarin Does Not Impact Outcome in Trauma Patients</atitle><jtitle>The journal of trauma</jtitle><addtitle>J Trauma</addtitle><date>2001-12</date><risdate>2001</risdate><volume>51</volume><issue>6</issue><spage>1147</spage><epage>1152</epage><pages>1147-1152</pages><issn>0022-5282</issn><eissn>1529-8809</eissn><abstract>OBJECTIVE The objective of this study was to determine whether the preinjury condition of anticoagulation had an adverse impact on patients sustaining injury.
METHODS A retrospective analysis was performed for prospectively collected registry data from 1995–2000 from all accredited trauma centers in Pennsylvania. The registry was queried for all trauma patients who had anticoagulation therapy as a preinjury condition (PIC). This group served as our experimental cohort. A control cohort (not having warfarin therapy as a PIC) was developed using case-matching techniques for age, sex, Glasgow Coma Scale (GCS), Injury Severity Score (ISS), A Severity Characterization of Trauma (ASCOT) score, and in the head injured patients, International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnoses. Head and non-head injured patients were evaluated separately. The cohorts were examined for 28-day mortality, intensive care unit length of stay (ICU-LOS), hospital length of stay (HOS-LOS), PICs, occurrences, discharge destinations, and functional status at discharge. χ and Student’s t test were used to evaluate the data;p values < 0.05 were considered significant.
RESULTS Two thousand nine hundred forty-two patients were available for analysis. The prevalence of PICs was significantly greater in the warfarin group for both the head and non-head injured populations (p < 0.003 and p < 0.0001, respectively). The incidence of occurrences in the non-head injured population was statistically higher for the warfarin patients (p < 0.001), but showed no difference in the head injured group regardless of warfarin use (p = 0.15). Functional status at discharge demonstrated no clinically significant difference between the warfarin and non-warfarin groups in both head and non-head injured populations. There was no difference in discharge destination in the head injured population; however, in the non-head injured population a greater percentage of non-warfarin patients was discharged to home when compared with the warfarin patients.
CONCLUSION Our data suggest that the PIC of anticoagulation with warfarin does not adversely impact mortality or LOS outcomes in both head and non-head injured patients. In non-head injured patients, however, the occurrence rates and discharge destination were different. More research needs to be done to determine whether this is related to anticoagulation or other reasons (i.e., number of PICs). These data should be used when weighing risk/benefit ratios of prescribing chronic anticoagulation.</abstract><cop>United States</cop><pub>Lippincott Williams & Wilkins, Inc</pub><pmid>11740267</pmid><doi>10.1097/00005373-200112000-00021</doi><tpages>6</tpages></addata></record> |
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| subjects | Aged Anticoagulants - adverse effects Case-Control Studies Cohort Studies Craniocerebral Trauma - etiology Craniocerebral Trauma - mortality Female Humans Injury Severity Score Length of Stay Male Patient Discharge Pennsylvania - epidemiology Prospective Studies Registries Retrospective Studies Trauma Centers Warfarin - adverse effects Wounds and Injuries - etiology Wounds and Injuries - mortality |
| title | Preinjury Warfarin Does Not Impact Outcome in Trauma Patients |
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