scholarly journals Mortality in trauma patients admitted during, before, and after national academic emergency medicine and trauma surgery meeting dates in Japan

2018 ◽  
Author(s):  
Tetsuya Yumoto ◽  
Hiromichi Naito ◽  
Hiromi Ihoriya ◽  
Takashi Yorifuji ◽  
Atsunori Nakao
Keyword(s):  
Hospital Mortality ◽  
Positive Impact ◽  
Multiple Logistic Regression Analysis ◽  
Traumatic Injury ◽  
Trauma Surgery ◽  
Data Bank ◽  
Trauma Patients ◽  
Japanese Association ◽  
Before And After ◽  
Japan Trauma Data Bank

AbstractAnnually, many physicians attend national academic meetings. While participating in these meetings can have a positive impact on daily medical practice, attendance may result in reduced medical staffing during the meeting dates. We sought to examine whether there were differences in mortality after trauma among patients admitted to the hospital during, before, and after meeting dates. Using the Japan Trauma Data Bank, we analyzed in-hospital mortality in patients with traumatic injury admitted to the hospital from 2004 to 2015 during the dates of two national academic meetings - the Japanese Association for Acute Medicine (JAAM) and the Japanese Association for the Surgery of Trauma (JAST). We compared the data with that of patients admitted with trauma during identical weekdays in the weeks before and after the meetings, respectively. We used multiple logistic regression analysis to compare outcomes among the three groups. A total of 7,491 patients were included in our analyses, with 2,481, 2,492, and 2,518 patients in the during, before, and after meeting dates groups, respectively; their mortality rates were 7.3%, 8.0%, and 8.5%, respectively. After adjusting for covariates, no significant differences in in-hospital mortality were found among the three groups (adjusted odds ratio [95% CI] of the before meeting dates and after meeting dates groups; 1.18 [0.89-1.56] and 1.23 [0.93-1.63], respectively, with the during meeting dates group as the reference category). No significant differences in in-hospital mortality were found among trauma patients admitted during, before, and after the JAAM and JAST meeting dates.

scholarly journals Survival outcomes after traumatic brain injury during national academic meeting days in Japan

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Sanae Hosomi ◽  
Tetsuhisa Kitamura ◽  
Tomotaka Sobue ◽  
Hiroshi Ogura ◽  
Takeshi Shimazu
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Hospital Mortality ◽  
Data Bank ◽  
Hospital Death ◽  
National Meeting ◽  
Japanese Association ◽  
Neurosurgical Society ◽  
Before And After ◽  
Japan Trauma Data Bank

AbstractSurgeons and medical staff attend academic meetings several times a year. However, there is insufficient evidence on the influence of the “meeting effect” on traumatic brain injury (TBI) treatments and outcomes. Using the Japan Trauma Data Bank, we analyzed the data of TBI patients admitted to the hospital from 2004 to 2018 during the national academic meeting days of the Japanese Association for Acute Medicine, the Japanese Society of Intensive Care Medicine, the Japanese Association for the surgery of trauma, the Japan Society of Neurotraumatology and the Japan Neurosurgical Society. The data of these patients were compared with those of TBI patients admitted 1 week before and after the meetings. The primary outcome was in-hospital death. We included 7320 patients in our analyses, with 5139 and 2181 patients admitted during the non-meeting and meeting days, respectively; their in-hospital mortality rates were 15.7% and 14.5%, respectively. No significant differences in in-hospital mortality were found (adjusted odds ratio, 0.93; 95% confidence interval, 0.78–1.11). In addition, there were no significant differences in in-hospital mortality during the meeting and non-meeting days by the type of national meeting. In Japan, it is acceptable for medical professionals involved in TBI treatments to attend national academic meetings without impacting the outcomes of TBI patients.

scholarly journals Association of body temperature with in-hospital mortality among paediatric trauma patients: an analysis of a nationwide observational trauma database in Japan

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e033822
Author(s):  
Asami Okada ◽  
Yohei Okada ◽  
Hiromichi Narumiya ◽  
Wataru Ishii ◽  
Tetsuhisa Kitamura ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Body Temperature ◽  
Hospital Mortality ◽  
Multivariate Logistic Regression Analysis ◽  
Data Bank ◽  
Trauma Patients ◽  
Multivariate Logistic Regression ◽  
Hospital Arrival ◽  
Paediatric Trauma ◽  
Japan Trauma Data Bank

ObjectivesTo examine the association between body temperature (BT) on hospital arrival and in-hospital mortality among paediatric trauma patients.DesignA retrospective cohort study.SettingJapan Trauma Data Bank (JTDB, which is a nationwide, prospective, observational trauma registry with data from 235 hospitals).ParticipantsPaediatric trauma patients <16 years old who were transferred directly from the scene of injury to the hospital and registered in the JTDB from January 2004 to December 2017 were included. We excluded patients >16 years old and those who developed cardiac arrest before or on hospital arrival.Primary outcomeThe association between BT on hospital arrival and in-hospital mortality. We conducted multivariate logistic regression analyses to calculate the adjusted ORs, with their 95% CIs, of the association between BT and in-hospital mortality.ResultsA total of 9012 patients were included (median age: 9 years (IQR, 6.0–13.0 years), mortality: 2.5% (mortality number was 226 in total 9012 patients)). In the multivariate logistic regression analysis, the corresponding adjusted ORs of BT <36.0°C and BT ≥37.0°C, relative to a BT of 36°C–36.9°C, for in-hospital mortality were 2.83 (95% CI: 1.85 to 4.33) and 0.93 (95% CI: 0.53 to 1.63), respectively.ConclusionsIn paediatric patients with hypothermia (BT <36.0°C) on hospital arrival, a clear association with in-hospital mortality was observed; no such association was observed between higher BT values (≥37.0°C) and outcomes.

Clinical Characteristics of Trauma Patients Requiring Hydrocortisone Treatment for Refractory Hypotension

2017 ◽  
Vol 83 (8) ◽  
pp. 821-824
Author(s):  
Gina Kim ◽  
Jeffrey Young
Keyword(s):  
Hospital Mortality ◽  
Injury Severity ◽  
Traumatic Injury ◽  
Patient Characteristics ◽  
Data Repository ◽  
Trauma Patients ◽  
Lower Blood ◽  
Refractory Hypotension ◽  
The University ◽  
Stress Dose

Corticosteroids play an important role in responding to physiologic stress in the human body. However, its application in critical care remains heavily debated. The purpose of this study was to identify patient characteristics associated with receiving stress-dose steroids during the intensive care unit stay after traumatic injury and its effect on in-hospital mortality. Patients admitted to the University of Virginia trauma center between January 1, 2011, and December 31, 2015, were identified using our Trauma Registry. Stress dose steroids were defined as 100 mg IV hydrocortisone every eight hours. Patients who received stress-dose steroids were identified using the Clinical Data Repository. Patient characteristics associated with increased likelihood of receiving stress-dose steroids during admission were age >65, diabetes mellitus, congestive heart failure, burn injuries, Injury Severity Score >15, lower blood pressure (141/80 vs 125/76 mm Hg), and higher heart rate (87 vs 94/min). Patients who received stress-dose steroids were found to have increased mortality but not after controlling for the aforementioned patient factors associated with increased likelihood of receiving stress-dose steroids. The use of stress-dose steroids in critically ill patients with refractory hypotension does not appear to affect in-hospital mortality.

Epidemiology of Traumatic Esophageal Injury: An Analysis of the National Trauma Data Bank

2019 ◽  
Vol 85 (4) ◽  
pp. 342-349 ◽  
Author(s):  
Alexander A. Xu ◽  
Janis L. Breeze ◽  
Jessica K. Paulus ◽  
Nikolay Bugaev
Keyword(s):  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Traumatic Injury ◽  
Data Bank ◽  
Esophageal Injury ◽  
Trauma Patients ◽  
Adult Age ◽  
National Trauma ◽  
National Trauma Data Bank

Existing literature on traumatic injury of the esophagus (TIE) is limited. We aimed to describe the clinical characteristics and outcomes of TIE. We reviewed the National Trauma Data Bank for the years 2010–2015. We described the demographics, characteristics, and outcomes of adult (age ≥16 years) TIE patients and also compared those factors in blunt versus penetrating TIE. The association between TIE and mortality was analyzed using multivariable logistic regression. Thousand four hundred eleven adult TIE patients were identified (37 per 100,000 trauma patients, 95% confidence intervals (CI): 35, 39). TIE patients were younger (38 vs 52 years), more likely to be male (81% vs 62%), and more severely injured (Injury Severity Score ≥ 25: 45% vs 7%) than patients without TIE (all P < 0.001). TIE was observed 16 times more frequently with penetrating injuries (257 per 100,000, 95% CI: 240, 270) than with blunt injuries (16 per 100,000, 95% CI: 15, 18). Inhospital TIE mortality was 19 per cent. TIE patients had greater risk of mortality than other trauma patients, after adjusting for age, gender, and Injury Severity Score (odds ratio = 1.4, 95% CI: 1.1, 1.7). Mortality in blunt and penetrating TIE did not differ. Although extremely rare, TIE is independently associated with a marked increase in mortality, even after adjusting for other risk factors.

scholarly journals Revision of ‘golden hour’ for hemodynamically unstable trauma patients: an analysis of nationwide hospital-based registry in Japan

2020 ◽  
Vol 5 (1) ◽  
pp. e000405
Author(s):  
Kazuhiro Okada ◽  
Hisashi Matsumoto ◽  
Nobuyuki Saito ◽  
Takanori Yagi ◽  
Mihye Lee
Keyword(s):  
Positive Impact ◽  
Additive Model ◽  
Data Bank ◽  
Shock Group ◽  
Trauma Patients ◽  
Level Of Evidence ◽  
Golden Hour ◽  
Impact On Survival ◽  
The Relationship ◽  
Time From Injury

BackgroundThe ‘golden hour’ is a well-known concept, suggesting that shortening time from injury to definitive care is critically important for better outcome of trauma patients. However, there was no established evidence to support it. We aimed to validate the association between time to definitive care and mortality in hemodynamically unstable patients for the current trauma care settings.MethodsThe data were collected from the Japan Trauma Data Bank between 2006 and 2015. The inclusion criteria were patients with systolic blood pressure (SBP) <90 mm Hg and heart rate (HR) >110 beats/min or SBP <70 mm Hg who underwent definitive care within 4 hours from the onset of injury and survived for more than 4 hours. The outcome measure was in-hospital mortality. We evaluated the relationship between time to definitive care and mortality using the generalized additive model (GAM). Subgroup analysis was also conducted using GAM after dividing the patients into the severe (SBP <70 mm Hg) and moderate (SBP ≥70 mm Hg and <90 mm Hg, and HR >110 beats/min) shock group.Results1169 patients were enrolled in this study. Of these, 386 (33.0%) died. Median time from injury to definitive care was 137 min. Only 61 patients (5.2%) received definitive care within 60 min. The GAM models demonstrated that mortality remained stable for the early phase, followed by a decrease over time. The severe shock group presented with a paradoxical decline of mortality with time, whereas the moderate shock group had a time-dependent increase in mortality.DiscussionWe did not observe the association of shorter time to definitive care with a decrease in mortality. However, this was likely an offset result of severe and moderate shock groups. The result indicated that early definitive care could have a positive impact on survival outcome of patients with moderate shock.Level of evidenceLevel Ⅳ, prognostic study,

scholarly journals Association of Japan Coma Scale score on hospital arrival with in-hospital mortality among trauma patients

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Tetsuya Yumoto ◽  
Hiromichi Naito ◽  
Takashi Yorifuji ◽  
Toshiyuki Aokage ◽  
Noritomo Fujisaki ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Hospital Mortality ◽  
Logistic Regression Analysis ◽  
Multiple Logistic Regression Analysis ◽  
Trauma Patients ◽  
Multiple Logistic Regression ◽  
Point Scale ◽  
Hospital Arrival ◽  
Coma Scale

Abstract Background The Japan Coma Scale (JCS) score has been widely used to assess patients’ consciousness level in Japan. JCS scores are divided into four main categories: alert (0) and one-, two-, and three-digit codes based on an eye response test, each of which has three subcategories. The purpose of this study was to investigate the utility of the JCS score on hospital arrival in predicting outcomes among adult trauma patients. Methods Using the Japan Trauma Data Bank, we conducted a nationwide registry-based retrospective cohort study. Patients 16 years old or older directly transported from the trauma scene between January 2004 and December 2017 were included. Our primary outcome was in-hospital mortality. We examined outcome prediction accuracy based on area under the receiver operating characteristic curve (AUROC) and multiple logistic regression analysis with multiple imputation. Results A total of 222,540 subjects were included; their in-hospital mortality rate was 7.1% (n = 15,860). The 10-point scale JCS and the total sum of Glasgow Coma Scale (GCS) scores demonstrated similar performance, in which the AUROC (95% CIs) showed 0.874 (0.871–0.878) and 0.878 (0.874–0.881), respectively. Multiple logistic regression analysis revealed that the higher the JCS score, the higher the predictability of in-hospital death. When we focused on the simple four-point scale JCS score, the adjusted odds ratio (95% confidence intervals [CIs]) were 2.31 (2.12–2.45), 4.81 (4.42–5.24), and 27.88 (25.74–30.20) in the groups with one-digit, two-digit, and three-digit scores, respectively, with JCS of 0 as a reference category. Conclusions JCS score on hospital arrival after trauma would be useful for predicting in-hospital mortality, similar to the GCS score.

scholarly journals Early experience of a regional trauma center in Gangwon province: First step toward organizing a regional trauma system

2019 ◽  
Vol 27 (4) ◽  
pp. 202-210
Author(s):  
Kwangmin Kim ◽  
Hongjin Shim ◽  
Pil Young Jung ◽  
Seongyup Kim ◽  
Hui-Jae Bang ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Injury Severity Score ◽  
Severity Score ◽  
Trauma Center ◽  
Injury Severity ◽  
Trauma System ◽  
Mortality Rates ◽  
Trauma Patients ◽  
Before And After ◽  
The Impact

Background: The Korean Ministry of Health and Welfare decided to establish a trauma medical service system to reduce preventable deaths. OO hospital in Gangwon Province was selected as a regional trauma center and was inaugurated in 2015. Objectives: This study examines the impact of this center, comparing mortality and other variables before and after inaugurating the center. Methods: Severely injured patients (injury severity score > 15) presenting to OO hospital between January 2014 and December 2016 were enrolled and categorized into two groups: before trauma center (n = 365) and after trauma center (n = 904). Patient characteristics, variables, and patient outcomes (including mortality rate) before and after the establishment of trauma centers were compared accordingly for both groups. Risk factors for in-hospital mortality were also identified. Results: Probability of survival using trauma and injury severity score (%) method was significantly lower in the after trauma center group (81.3 ± 26.1) than in the before trauma center group (84.7 ± 21.0) (p = 0.014). In-hospital mortality rates were similar in both groups (before vs after trauma center group: 13.2% vs 14.2%; p = 0.638). The Z and W statistics revealed higher scores in the after trauma center group than in the before trauma center group (Z statistic, 4.69 vs 1.37; W statistic, 4.52 vs 2.10); 2.42 more patients (per 100 patients) survived after trauma center establishment. Conclusion: Although the mortality rates of trauma patients remained unchanged after the trauma center establishment, the Z and W statistics revealed improvements in the quality of care.

Excess Mortality, Length of Stay, and Costs Associated with Serious Hemorrhage among Trauma Patients: Findings from the National Trauma Data Bank®

2007 ◽  
Vol 73 (12) ◽  
pp. 1269-1274 ◽  
Author(s):  
Luke Boulanger ◽  
Ashish V. Joshi ◽  
Bartholomew J. Tortella ◽  
Joseph Menzin ◽  
John P. Caloyeras ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Blunt Trauma ◽  
Excess Mortality ◽  
Penetrating Trauma ◽  
Length Of Hospital Stay ◽  
Data Bank ◽  
The Body ◽  
Trauma Patients ◽  
Lengths Of Stay ◽  
Serious Injury

Trauma is a serious injury or shock to the body from violence or crash and is an important and growing global health risk. Using 2000 to 2004 data from a comprehensive trauma registry, we estimated the prevalence of serious blunt and penetrating trauma-related hemorrhage among patients admitted to U.S. trauma centers along with excess in-hospital mortality, length of hospital stay, and inpatient costs. There were 65,750 patients with blunt trauma and 12,992 patients with penetrating trauma included in our analyses. Of patients sustaining blunt trauma, 7.6 per cent had serious hemorrhage; 18.8 per cent of patients sustaining penetrating trauma had serious hemorrhage. In-hospital mortality rates were significantly ( P < 0.05) higher for patients with serious hemorrhage than for patients without (24.9 per cent versus 8.4 per cent for blunt; 23.4 per cent versus 4.2 per cent for penetrating). Patients with serious hemorrhage had adjusted mean excess lengths of stay of 0.4 days for blunt trauma and 2.7 days for penetrating trauma ( P < 0.05); adjusted excess costs were $296 per day for patients sustaining blunt trauma and $637 per day for patients sustaining penetrating trauma ( P < 0.05). In both blunt and penetrating trauma cases, serious hemorrhage is significantly associated with excess mortality, longer hospital stays, and higher costs.

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