Assessment of Progress in Early Trauma Care in Japan over the Past Decade: Achievements and Areas for Future Improvement
Assessment of Progress in Early Trauma Care in Japan over the Past Decade: Achievements and Areas for Future Improvement
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DOI：
10.1016/j.jamcollsurg.2016.10.051
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发表时间：
2017-02-01
影响因子：
5.2
通讯作者：
Otomo, Yasuhiro
中科院分区：
文献类型：
--
作者：
Endo, Akira;Shiraishi, Atsushi;Otomo, Yasuhiro
背景：日本已推出优化早期创伤护理的策略；研究设计：在这项回顾性观察研究中，在日本全国创伤登记处登记的患者根据生存概率 (Ps) > 0.5 或 0.5（早期，25,917 例；晚期，55,032 例）进行分层，Ps 0.5 组为 8,898 例，Ps 为 0.67 [0.60 至 0.76] 组为 0.67 例（0.60 至 0.76）。 Ps>0.5组）。两组的院内死亡率也显着降低（AOR [95% CI] 分别为 0.70 [0.64 至 0.76] 和 0.73 [0.64 至 0.82]）。在到达时修订创伤评分 >= 7 或腹部简明损伤量表 (AIS) >= 3 的患者中观察到显着改善。在头部 AIS >= 3 的患者和接受开胸手术的患者中观察到有限的改善。 结论：虽然早期创伤护理总体上有所改善，但具体进展各不相同。对严重头部损伤或接受开胸手术的患者进行集中小组审查可能是进一步改善的有效策略。 （J Am Coll Surg 2017；224：191e198。(C) 2016，美国外科医师学会。由爱思唯尔公司出版。保留所有权利。）
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 (early, 25,917; late, 55,032) and 8,898 patients with Ps 0.5 group and 0.67 [0.60 to 0.76] in the Ps > 0.5 group). In-hospital mortality rates in both groups were also significantly reduced (AOR [95% CI] 0.70 [0.64 to 0.76] and 0.73 [0.64 to 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: Although early trauma care has generally improved, specific progress was variable. Focused panel review of patients with severe head injury or undergoing thoracotomy may be an efficient strategy for further improvement. (J Am Coll Surg 2017; 224: 191e198. (C) 2016 by the American College of Surgeons. Published by Elsevier Inc. All rights reserved.)