Comparison of trauma outcomes between Japan and the USA using national trauma registries

Abstract

BackgroundThe National Trauma Data Bank (NTDB) has served as a global benchmark for trauma care quality and outcomes. Herein, we compared patient characteristics, trauma management, and outcomes between Japanese emergency and critical care centers and US level 1 trauma centers using the Japanese Trauma Data Bank (JTDB) and NTDB.MethodsA retrospective cohort matching (1:1) study was performed. Patients treated in 2013 with an Injury Severity Score ≥9 were included. The primary outcome measure was in-hospital mortality. The secondary outcome measures included the hospital length of stay and the rate of use of radiological diagnostic modalities.ResultsA total of 14 960 pairs with well-balanced characteristics were generated from 22 535 and 112 060 eligible patients in the JTDB and NTDB, respectively. Before matching, the in-hospital mortality was higher in the JTDB than in the NTDB (7.6% vs. 6.1%; OR, 1.28; 95% CI 1.21 to 1.35). However, after matching, the in-hospital mortality was lower in the JTDB cohort (4.2% vs. 5.8%; OR, 0.72; 95% CI 0.65 to 0.80). CT scans were used in >80% of JTDB patients, which was more than 1.5 times as often as the use in the NTDB cohort. In subgroup analyses, only patients who received a blood transfusion had a poorer survival outcome in the JTDB compared with the NTDB (OR, 1.32; 95% CI 1.07 to 1.64).DiscussionWe observed marked differences in trauma care between Japan and the USA. Although the quality of the recent Japanese trauma care appears to be approaching that of the USA, it may be further improved, such as by the establishment of transfusion protocols.Level of evidenceLevel IV.

Epidemiology of trauma in France: mortality and risk factors based on a national medico-administrative database

“…75 years [17]. Same results were reported elsewhere [18,19]. Interestingly, comorbidities were reported in 35% of our cohort, which was unexpected for this population.…”

The risk to future pregnancies of transfusing Rh(D)‐negative females of childbearing potential with Rh(D)‐positive red blood cells during trauma resuscitation is dependent on their age at transfusion

“…The rate of HDFN was modelled using published data from the following countries: Australia, Brazil, China, India, Japan, Nigeria, Trinidad and Tobago and United States [7–41]. Critical assumptions used in the model, that is, the computation of HDFN risk based on the independent variables employed, and supporting literature are provided in Table 1.…”

Atención de los pacientes con trauma grave durante los primeros días: evolución entre la urgencia, el pabellón y la unidad de cuidados intensivos

“…Varios de los procedimientos a los que fueron sometidos los pacientes en el SUA, así como el tiempo de permanencia en este, fueron semejantes a lo descrito en estudios de países desarrollados 11,15 . Sin embargo, el tiempo en urgencia debería ser el mínimo posible, especialmente en pacientes de trauma inestables y con sangrado activo.…”

“…Sin embargo, el tiempo en urgencia debería ser el mínimo posible, especialmente en pacientes de trauma inestables y con sangrado activo. El porcentaje de pacientes que requirió cirugía de urgencia fue mayor al reportado por centros de trauma de países desarrollados 15 , pero similar a lo descrito por centros chilenos 16 . Esto podría explicarse por la alta frecuencia de trauma penetrante y por los recursos disponibles, específicamente, por la falta de disponibilidad de radiología intervencional.…”