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Jayaraman S, DeAntonio JH, Leichtle SW, Han J, Liebrecht L, Contaifer D, Young C, Chou C, Staschen J, Doan D, Kumar NG, Wolfe L, Nguyen T, Chenault G, Anand RJ, Bennett JD, Ferrada P, Goldberg S, Procter LD, Rodas EB, Rossi AP, Whelan JF, Feeser VR, Vitto MJ, Broering B, Hobgood S, Mangino M, Aboutanos M, Bachmann L, Wijesinghe DS. Detecting direct oral anticoagulants in trauma patients using liquid chromatography-mass spectrometry: A novel approach to medication reconciliation. J Trauma Acute Care Surg 2020; 88:508-514. [PMID: 31688825 PMCID: PMC7802815 DOI: 10.1097/ta.0000000000002527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Accurate medication reconciliation in trauma patients is essential but difficult. Currently, there is no established clinical method of detecting direct oral anticoagulants (DOACs) in trauma patients. We hypothesized that a liquid chromatography-mass spectrometry (LCMS)-based assay can be used to accurately detect DOACs in trauma patients upon hospital arrival. METHODS Plasma samples were collected from 356 patients who provided informed consent including 10 healthy controls, 19 known positive or negative controls, and 327 trauma patients older than 65 years who were evaluated at our large, urban level 1 trauma center. The assay methodology was developed in healthy and known controls to detect apixaban, rivaroxaban, and dabigatran using LCMS and then applied to 327 samples from trauma patients. Standard medication reconciliation processes in the electronic medical record documenting DOAC usage were compared with LCMS results to determine overall accuracy, sensitivity, specificity, and positive and negative predictive values (PPV, NPV) of the assay. RESULTS Of 356 patients, 39 (10.96%) were on DOACs: 21 were on apixaban, 14 on rivaroxaban, and 4 on dabigatran. The overall accuracy of the assay for detecting any DOAC was 98.60%, with a sensitivity of 94.87% and specificity of 99.05% (PPV, 92.50%; NPV, 99.37%). The assay detected apixaban with a sensitivity of 90.48% and specificity of 99.10% (PPV, 86.36%; NPV 99.40%). There were three false-positive results and two false-negative LCMS results for apixaban. Dabigatran and rivaroxaban were detected with 100% sensitivity and specificity. CONCLUSION This LCMS-based assay was highly accurate in detecting DOACs in trauma patients. Further studies need to confirm the clinical efficacy of this LCMS assay and its value for medication reconciliation in trauma patients. LEVEL OF EVIDENCE Diagnostic Test, level III.
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Affiliation(s)
- Sudha Jayaraman
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University School of Medicine
| | - Jonathan H. DeAntonio
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University School of Medicine
| | - Stefan W. Leichtle
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University School of Medicine
| | - Jinfeng Han
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University School of Medicine
| | - Loren Liebrecht
- Department of Internal Medicine, Virginia Commonwealth University School of Medicine
| | - Daniel Contaifer
- Department of Pharmacotherapy and Outcomes Sciences, Virginia Commonwealth University School of Pharmacy
| | | | | | | | - David Doan
- Department of Pharmacotherapy and Outcomes Sciences, Virginia Commonwealth University School of Pharmacy
| | - Naren Gajenthra Kumar
- Department of Pharmacotherapy and Outcomes Sciences, Virginia Commonwealth University School of Pharmacy
| | - Luke Wolfe
- Department of Surgery Virginia Commonwealth University School of Medicine
| | - Tammy Nguyen
- Department of Emergency Medicine, Virginia Commonwealth University School of Medicine
| | | | - Rahul J. Anand
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University School of Medicine
| | - Jonathan D. Bennett
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University School of Medicine
| | - Paula Ferrada
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University School of Medicine
| | - Stephanie Goldberg
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University School of Medicine
| | - Levi D. Procter
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University School of Medicine
| | - Edgar B. Rodas
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University School of Medicine
| | - Alan P. Rossi
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University School of Medicine
| | - James F. Whelan
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University School of Medicine
| | - V. Ramana Feeser
- Department of Emergency Medicine, Virginia Commonwealth University School of Medicine
| | - Michael J. Vitto
- Department of Emergency Medicine, Virginia Commonwealth University School of Medicine
| | - Beth Broering
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University School of Medicine
| | - Sarah Hobgood
- Division of Geriatric Medicine, Department of Internal Medicine, Virginia Commonwealth University School of Medicine
| | - Martin Mangino
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University School of Medicine
| | - Michel Aboutanos
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University School of Medicine
| | | | - Dayanjan S Wijesinghe
- Department of Pharmacotherapy and Outcomes Sciences, Virginia Commonwealth University School of Pharmacy
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DeAntonio JH, Nguyen T, Chenault G, Aboutanos MB, Anand RJ, Ferrada P, Goldberg S, Leichtle SW, Procter LD, Rodas EB, Rossi AP, Whelan JF, Feeser VR, Vitto MJ, Broering B, Hobgood S, Mangino M, Wijesinghe DS, Jayaraman S. Medications and patient safety in the trauma setting: a systematic review. World J Emerg Surg 2019; 14:5. [PMID: 30815027 PMCID: PMC6377727 DOI: 10.1186/s13017-019-0225-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 02/03/2019] [Indexed: 02/17/2023] Open
Abstract
Background Medication errors account for the most common adverse events and a significant cause of mortality in the USA. The Joint Commission has required medication reconciliation since 2006. We aimed to survey the literature and determine the challenges and effectiveness of medication reconciliation in the trauma patient population. Materials and methods We conducted a systematic review of the literature to determine the effectiveness of medication reconciliation in trauma patients. English language articles were retrieved from PubMed/Medline, CINAHL, and Cochrane Review databases with search terms "trauma OR injury, AND medication reconciliation OR med rec OR med rek, AND effectiveness OR errors OR intervention OR improvements." Results The search resulted in 82 articles. After screening for relevance and duplicates, the 43 remaining were further reviewed, and only four articles, which presented results on medication reconciliation in 3041 trauma patients, were included. Two were retrospective and two were prospective. Two showed only 4% accuracy at time of admission with 48% of medication reconciliations having at least one medication discrepancy. There were major differences across the studies prohibiting comparative statistical analysis. Conclusions Trauma medication reconciliation is important because of the potential for adverse outcomes given the emergent nature of the illness. The few articles published at this time on medication reconciliation in trauma suggest poor accuracy. Numerous strategies have been implemented in general medicine to improve its accuracy, but these have not yet been studied in trauma. This topic is an important but unrecognized area of research in this field.
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Affiliation(s)
- Jonathan H. DeAntonio
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
- Department of Surgery, VCU School of Medicine, VCU Health System, Virginia Commonwealth University, Richmond, Virginia USA
| | - Tammy Nguyen
- Department of Emergency Medicine, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
| | - Gregory Chenault
- VCU Health Department of Pharmacy Services, Critical Care, Richmond, Virginia USA
| | - Michel B. Aboutanos
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
| | - Rahul J. Anand
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
| | - Paula Ferrada
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
| | - Stephanie Goldberg
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
| | - Stefan W. Leichtle
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
| | - Levi D. Procter
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
| | - Edgar B. Rodas
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
- Program for Global Surgery, Department of Surgery, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
| | - Alan P. Rossi
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
| | - James F. Whelan
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
| | - V. Ramana Feeser
- Department of Emergency Medicine, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
| | - Michael J. Vitto
- Department of Emergency Medicine, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
| | - Beth Broering
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
| | - Sarah Hobgood
- Division of Geriatrics, Department of Internal Medicine, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
| | - Martin Mangino
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
| | - Dayanjan S. Wijesinghe
- Department of Pharmacotherapy and Outcomes Sciences and Laboratory of Pharmacometabolomics and Companion Diagnostics, Virginia Commonwealth University School of Pharmacy, VCU Health, Richmond, Virginia USA
| | - Sudha Jayaraman
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
- Program for Global Surgery, Department of Surgery, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
- VCU School of Medicine, Richmond, Virginia USA
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