Ten-year in-hospital mortality trends among Japanese injured patients by age, injury severity, injury mechanism, and injury region: A nationwide observational study

Abstract

The Injury Severity Score (ISS) is widely used in trauma research worldwide. An ISS cutoff value of ≥16 is frequently used as the definition of severe injury in Japan. The mortality of patients with ISS ≥16 has decreased in recent years, owing to the developing the trauma care system. This study aimed to analyze the prevalence, in-hospital mortality, and odds ratio (OR) for mortality in Japanese injured patients by age, injury mechanism, injury region, and injury severity over 10 years. This study used the Japan Trauma Data Bank (JTDB) dataset, which included 315,614 patients registered between 2009 and 2018. 209,290 injured patients were utilized. This study evaluated 10-year trends of the prevalence and in-hospital mortality and risk factors associated with in-hospital mortality. The overall in-hospital mortality was 10.5%. During the 10-year study period in Japan, the mortality trend among all injured patient groups with ISS 0–15, 16–25, and ≥26 showed significant decreases (p <0.001). Moreover, the mortality risk of patients with ISS ≥26 was significantly higher than that of patients with ISS 0–15 and 16–25 (p <0.001, OR = 0.05 and p<0.001, OR = 0.22). If we define injured patients who are expected to have a mortality rate of 20% or more as severely injured, it may be necessary to change the injury severity definition according to reduction of trauma mortality as ISS cutoff values to ≥26 instead of ≥16. From 2009 to 2018, the in-hospital mortality trend among all injured patient groups with ISS 0–15, 16–25, and ≥26 showed significant decreases in Japan. Differences were noted in mortality trends and risks according to anatomical injury severity.

Incidence, demographics and outcomes of patients with penetrating injury: a Japanese nationwide 10-year retrospective study

“…This was much higher than that in other countries, with a median age of 30 years in Sweden and a mean age of 31 years in London and 39 years in Germany 10–12. Previous reports have shown that there were differences in the medical resources available for the trauma care and mortality risk according to age, mechanism, injury region and injury severity 6 7 10–13. Therefore, it may be effective to focus on these mechanism-specific and age-specific characteristics and outcomes of patients with penetrating injury in order to establish a trauma care system suitable for Japanese patients.…”

“…Several nationwide cohort studies have reported that the mortality rate and risk of patients with severe injuries vary according to age, injury mechanism and/or injury severity 1–3 5–7. Injured patients with older age, penetrating injury and/or a higher Injury Severity Score (ISS) have a higher mortality risk 6 7.…”

“…Several nationwide cohort studies have reported that the mortality rate and risk of patients with severe injuries vary according to age, injury mechanism and/or injury severity 1–3 5–7. Injured patients with older age, penetrating injury and/or a higher Injury Severity Score (ISS) have a higher mortality risk 6 7. Specifically, severely injured patients with active bleeding have significantly high mortality risk and require early haemodynamic stabilisation to improve mortality rates 8.…”

Increased CT Use and No Change in Injury Severity among Child Motor Vehicle Victims: A National Trauma Database Study in Japan

“…A 10-year review of child injuries in Australia revealed that having a head injury and greater injury severity were associated with higher mortality rates [13]. In Japan, a report using the JTDB examined in-hospital mortality trends among injured patients between 2009 and 2018 [14]. The report suggested a significant decrease in mortality for the age group for the ages of 0-4 and 5-14 years [14].…”

Diaphragmatic Injuries among Severely Injured Patients (ISS ≥ 16)—An Indicator of Injury Pattern and Severity of Abdominal Trauma

“…In clinical routine, a full-body CT scan is recommended and performed as a standard of care when potentially life-threatening injuries are suspected [1][2][3][4][5][6]. Abdominal trauma, which is often present among severely injured patients, can lead to such life-threatening conditions that need immediate surgical intervention [6][7][8]. A traumatic injury to the diaphragm (TID) is a potentially challenging condition that is often accompanied by other thoracoabdominal injuries [9][10][11].…”