Assessment of the interaction effect between injury regions in multiple injuries: A nationwide cohort study in Japan

Tachino, Jotaro; Katayama, Yusuke; Kitamura, Tetsuhisa; Kiyohara, Kosuke; Nakao, Shunichiro; Umemura, Yutaka; Ishida, Kenichiro; Hirose, Tomoya; Nakagawa, Yuko; Shimazu, Takeshi

doi:10.1097/ta.0000000000002969

Cited by 9 publications

(10 citation statements)

References 38 publications

(11 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…TBI was defined as an injury to the brain due to an external force. Patients with TBI were screened with the Abbreviated Injury Scale (AIS) code [ 6 ]; we excluded cases with AIS ≥ 3 for all other body regions (chest, abdomen, and extremity), as polytrauma associated with TBI is known to increase the risk of mortality [ 7 ]. Furthermore, we excluded patients with a maximum head AIS score of 6 (lethal injury) or 9 (unspecified injury); cardiopulmonary arrest on hospital arrival; a requirement for inter-hospital transport [ 8 , 9 ]; or missing data for variables required for the logistic regression analysis.…”

Section: Methodsmentioning

confidence: 99%

Sex and age differences in isolated traumatic brain injury: a retrospective observational study

et al. 2021

Self Cite

View full text Add to dashboard Cite

Background Among the many factors that may influence traumatic brain injury (TBI) progression, sex is one of the most controversial. The objective of this study was to investigate sex differences in TBI-associated morbidity and mortality using data from the largest trauma registry in Japan. Methods This retrospective, population-based observational study included patients with isolated TBI, who were registered in a nationwide database between 2004 and 2018. We excluded patients with extracranial injury (Abbreviated Injury Scale score ≥ 3) and removed potential confounding factors, such as non-neurological causes of mortality. Patients were stratified by age and mortality and post-injury complications were compared between males and females. Results A total of 51,726 patients with isolated TBI were included (16,901 females and 34,825 males). Mortality across all ages was documented in 12.01% (2030/16901) and 12.76% (4445/34825) of males and females, respectively. The adjusted odds ratio (OR) of TBI mortality for males compared to females was 1.32 (95% confidence interval [CI], 1.22–1.42]. Males aged 10–19 years and ≥ 60 years had a significantly higher mortality than females in the same age groups (10–19 years: adjusted OR, 1.97 [95% CI, 1.08–3.61]; 60–69 years: adjusted OR, 1.24 [95% CI, 1.02–1.50]; 70–79 years: adjusted OR, 1.20 [95% CI, 1.03–1.40]; 80–89 years: adjusted OR, 1.50 [95% CI, 1.31–1.73], and 90–99 years: adjusted OR, 1.72 [95% CI, 1.28–2.32]). In terms of the incidence of post-TBI neurologic and non-neurologic complications, the crude ORs were 1.29 (95% CI, 1.19–1.39) and 1.14 (95% CI, 1.07–1.22), respectively, for males versus females. This difference was especially evident among elderly patients (neurologic complications: OR, 1.27 [95% CI, 1.14–1.41]; non-neurologic complications: OR, 1.29 [95% CI, 1.19–1.39]). Conclusions In a nationwide sample of patients with TBI in Japan, males had a higher mortality than females. This disparity was particularly evident among younger and older generations. Furthermore, elderly males experienced more TBI complications than females of the same age.

show abstract

Section: Methodsmentioning

confidence: 99%

Sex and age differences in isolated traumatic brain injury: a retrospective observational study

et al. 2021

Self Cite

View full text Add to dashboard Cite

show abstract

“…We assessed trends in elderly patients with TBI. Furthermore, we considered isolated TBI and multiple trauma (a combination of trauma in the head and other regions) separately as trauma in multiple regions has been associated with a greater risk of traumatic death compared with isolated TBI [11]. Since the increasing number of elderly patients affects total mortality, we hypothesized that the trend of TBI-related mortality would worsen as society ages.…”

Section: Introductionmentioning

confidence: 99%

Nationwide improvements in geriatric mortality due to traumatic brain injury in Japan

et al. 2022

Self Cite

View full text Add to dashboard Cite

Background Traumatic brain injury (TBI), both isolated and in combination with extracranial lesions, is a global health problem associated with high mortality. Among various risk factors for poor clinical outcomes, age is the most important independent predictor of mortality in patients with TBI. TBI-related mortality is expected to increase as the society ages. However, in a super-aged society such as Japan, little is known about the trend of TBI-related mortality among older adults. Herein, we assessed the nationwide trend of the incidence and clinical outcomes of geriatric patients with TBI in Japan using the national Japanese Trauma Data Bank (JTDB) registry. Methods In this retrospective cohort study, cases of TBI (aged ≥65 years) in hospitals registered with the JTDB database between January 2004 and December 2018 were included. In-hospital mortality was the primary outcome, and mortality in the emergency department was the secondary outcome. The odds ratios (ORs) and 95% confidence intervals (CIs) for in-hospital deaths with respect to 3-year periods were assessed using multivariable analysis after adjusting for potential confounders. Results The main cause of TBI in older individuals was falls. The proportion of patients who died after hospitalization during the study period decreased markedly from 29.5% (194/657) during 2004–2006 to 14.2% (1309/9240) during 2016–2018 in the isolated TBI group (adjusted OR = 0.42, 95% CI: 0.33–0.53) and from 48.0% (119/248) during 2004–2006 to 21.7% (689/3172) during 2016–2018 in the multiple trauma group (adjusted OR = 0.32, 95% CI: 0.23–0.45). The adjusted ORs for the 3-year increment were 0.84 (95% CI: 0.81–0.88) and 0.78 (95% CI: 0.75–0.83) for the isolated TBI and multiple trauma groups, respectively. Conclusions Using the national JTDB registry, we demonstrated a nationwide reduction in TBI-related mortality. Our findings in the super-aged society of Japan may provide insight for the treatment of geriatric patients with TBI worldwide.

show abstract

“…High-mortality groups exhibited a high degree of impaired consciousness and were further divided into a severe traumatic brain injury group and a polytrauma group according to reasonable clinical parameters. In trauma epidemiology, associations between combinations of injured regions and trauma-related mortality have been examined using a logistic model that included interaction effects and demonstrated significant interactions with mortality in head–chest and chest–pelvic/extremities injuries [ 2 ]. In the present study, clustering analysis revealed that injuries to the chest, pelvis, and extremities in the polytrauma group were associated with a high mortality rate.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, correctly determining the effects of therapeutic interventions remains intractable. Studies using large-scale registry data have attempted to validate interaction effects to identify groups with fatal polytrauma and reported that specific combinations of injuries significantly affect patient outcomes [ 2 ]. Thus, in analyses that consider the effects of complex, nonlinear interactions may reveal the pathological conditions that interact with multiple factors.…”

Section: Introductionmentioning

confidence: 99%

Development of clinical phenotypes and biological profiles via proteomic analysis of trauma patients

et al. 2022

Self Cite

View full text Add to dashboard Cite

Background Trauma is a heterogeneous condition, and specific clinical phenotypes may identify target populations that could benefit from certain treatment strategies. In this retrospective study, we determined clinical phenotypes and identified new target populations of trauma patients and their treatment strategies. Methods We retrospectively analyzed datasets from the Japan Trauma Data Bank and determined trauma death clinical phenotypes using statistical machine learning techniques and evaluation of biological profiles. Results The analysis included 71,038 blunt trauma patients [median age, 63 (interquartile range [IQR], 40–78) years; 45,479 (64.0%) males; median Injury Severity Score, 13 (IQR, 9–20)], and the derivation and validation cohorts included 42,780 (60.2%) and 28,258 (39.8%) patients, respectively. Of eight derived phenotypes (D-1–D-8), D-8 (n = 2178) had the highest mortality (48.6%) with characteristic severely disturbed consciousness and was further divided into four phenotypes: D-8α, multiple trauma in the young (n = 464); D-8β, head trauma with lower body temperature (n = 178); D-8γ, severe head injury in the elderly (n = 957); and D-8δ, multiple trauma, with higher predicted mortality than actual mortality (n = 579). Phenotype distributions were comparable in the validation cohort. Biological profile analysis of 90 trauma patients revealed that D-8 exhibited excessive inflammation, including enhanced acute inflammatory response, dysregulated complement activation pathways, and impaired coagulation, including downregulated coagulation and platelet degranulation pathways, compared with other phenotypes. Conclusions We identified clinical phenotypes with high mortality, and the evaluation of the molecular pathogenesis underlying these clinical phenotypes suggests that lethal trauma may involve excessive inflammation and coagulation disorders.

show abstract

Assessment of the interaction effect between injury regions in multiple injuries: A nationwide cohort study in Japan

Cited by 9 publications

References 38 publications

Sex and age differences in isolated traumatic brain injury: a retrospective observational study

Sex and age differences in isolated traumatic brain injury: a retrospective observational study

Nationwide improvements in geriatric mortality due to traumatic brain injury in Japan

Development of clinical phenotypes and biological profiles via proteomic analysis of trauma patients

Contact Info

Product

Resources

About