Citation

Endo A, Shiraishi A, Matsui H, Hondo K, Otomo Y. J. Am. Coll. Surg. 2016; 224(2): 191-198.e5.

Affiliation

Trauma and Acute Critical Care Medical Center, Medical Hospital, Tokyo Medical and Dental University, Tokyo, Japan.

Copyright

(Copyright © 2016, American College of Surgeons, Publisher Elsevier Publishing)

DOI

10.1016/j.jamcollsurg.2016.10.051

PMID

27825915

Abstract

BACKGROUND: Strategies to optimize early trauma care have been introduced in Japan; however, detailed evaluation of the progress achieved has not been reported. STUDY DESIGN: In this retrospective observational study, patients registered in the Japanese nationwide trauma registry were stratified according to probability of survival (Ps) > 0.5 or ≤ 0.5, respectively. The mortality rates during the first two days and in-hospital mortality rates were compared between early (2004-2009) and late cohorts (2010-2014) in each group, using mixed effects logistic regression analysis. Improvement in mortality rates during the first two days among subgroups were also assessed.

RESULTS: We analyzed 80,949 patients with Ps > 0.5 (early, 25,917; late, 55,032) and 8,898 patients with Ps ≤ 0.5 (early, 3,511; late, 5,387). The mortality rates during the first two days in both groups were significantly reduced (odds ratio [95% CI] = 0.61 [0.53-0.69] in Ps > 0.5 group and 0.67 [0.60-0.76] in Ps ≤ 0.5 group). In-hospital mortality rates in both groups were also significantly reduced (odds ratio [95% CI] = 0.70 [0.64-0.76] and 0.73 [0.64-0.82], respectively). Significant improvements were observed in patients with a revised trauma score ≥ 7 on arrival or an abbreviated injury scale (AIS) of the abdomen ≥ 3. Limited improvements were observed in patients with head AIS ≥ 3 and in patients who underwent thoracotomy.

CONCLUSIONS: While early trauma care has generally improved, specific progress was variable. Focused peer review of patients with severe head injury or undergoing thoracotomy may be an efficient strategy for further improvement.

Copyright © 2016. Published by Elsevier Inc.

Language: en