Introduction
Patients with combined burn and trauma are common in the United States and combined trauma in the burn increase the mortality. On contrast, their characteristics and outcomes remain unknown in Japan. The aim of present study was to elucidate the characteristics of trauma combined burn in Japan.
Methods
A multicenter retrospective study was performed between 2004 and 2017 using data from the Japan Trauma Data Bank (JTDB). We evaluated characteristics in burn patients (n=5,783) by segregating them into two groups cohorts: burn only (n=5,537) and combined burn and trauma(n=246). Clinical characteristics such as patient background, severity of burn and trauma, mechanism of injuries, total body surface area (TBSA), injury lesion, treatment and outcome were examined.
Results
The results showed significant differences in age between the burn only group and combined burn and trauma group (median [IQR]: 61 [43–76] for burn only group vs 51 [39–66] for combined burn and trauma group, p < 0.001). Most patients were injured due to flame (burn only group, 65.7%; combined burn and trauma group, 54.9%). Furthermore, 40-89% TBSA was higher in burn only group (19.3%) than in the combined burn and trauma group (9.3%). In-hospital mortality in burn only group (18.2%) was higher than that in the combined burn and trauma group (6.9%).
Conclusions
We demonstrated that the characteristics of burn only and combined burn and trauma patients in Japan. Flame was main cause of burn and in-hospital mortality was higher in burn only group because of higher burn area.
BackgroundMore than half of the world’s population lives in Asia. With current life expectancies in Asian countries, the burden of cardiovascular disease is increasing exponentially. Overcrowding in the emergency departments (ED) has become a public health problem. Since 2015, the European Society of Cardiology recommends the use of a 0/1-h algorithm based on high-sensitivity cardiac troponin (hs-cTn) for rapid triage of patients with suspected non-ST elevation acute coronary syndrome (NSTE-ACS). However, these algorithms are currently not recommended by Asian guidelines due to the lack of suitable data.MethodsThe DROP-Asian ACS is a prospective, stepped-wedge, cluster-randomized trial enrolling 4,080 participants presenting with chest pain to the ED of eleven centers in five Asian countries within 20.5 months (UMIN; 000042461). Initially, all clusters will apply 'usual care' according to local standard operating procedures including hs-cTnT but not the 0/1-h algorithm. Every 1.5 months, one cluster will randomly be allocated to switch to the 0/1-h algorithm using hs-cTnT. The primary outcome is the incidence of major adverse cardiac events (MACE), the composite of all-cause death, myocardial infarction, unstable angina or revascularization within 30 days. The difference in MACE (with one-sided 95% CI) was estimated to evaluate non-inferiority. The non-inferiority margin was prespecified at 1.5%. Secondary efficacy outcomes include costs for healthcare resources and duration of stay in ED. ConclusionsThis study provides important evidence concerning the safety and efficacy of the 0/1-h algorithm in Asian countries and may help to reduce congestion of the ED as well as medical costs.
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