Correlation between Hospital Volume of Severely Injured Patients and In-Hospital Mortality of Severely Injured Pediatric Patients in Japan: A Nationwide 5-Year Retrospective Study

Toida, Chiaki; Muguruma, Takashi; Gakumazawa, Masayasu; Shinohara, Mafumi; Abe, Takeru; Takeuchi, Ichiro; Morimura, Naoto

doi:10.3390/jcm10071422

Cited by 4 publications

(8 citation statements)

References 26 publications

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“…Among the studied volume-outcome associations, 18 analyses were adjusted for patient demographics and injury severity ( Table 3 ). Of the 17 studies included, 16 explored the volume’s impact on effectivity (mortality) [ 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ], 5 on efficiency [ 10 , 13 , 15 , 20 , 23 ], 2 on safety [ 11 , 23 ], and 4 on timeliness [ 20 , 21 , 23 , 26 ].…”

Section: Resultsmentioning

confidence: 99%

Trauma Patient Volume and the Quality of Care: A Scoping Review

Foppen,

Claassen,

Falck

et al. 2023

JCM

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Background: Healthcare stakeholders in the Netherlands came to an agreement in 2022 to deal with present and future challenges in healthcare. Among others, this agreement contains clear statements regarding the concentration of trauma patients, including the minimal required number of annual severe trauma patients for Major Trauma Centers. This review investigates the effects of trauma patient volumes on several domains of the quality of healthcare. Methods: PubMed was searched; studies published during the last 10 years reporting quantitative data on trauma patient volume and quality of healthcare were included. Results were summarized and categorized into the quality domains of healthcare. Results: Seventeen studies were included with a total of 1,517,848 patients. A positive association between trauma patient volume and survival was observed in 11/13 studies with adjusted analyses. Few studies addressed other quality domains: efficiency (n = 5), safety (n = 2), and time aspects of care (n = 4). None covered people-centeredness, equitability, or integrated care. Conclusions: Most studies showed a better survival of trauma patients when treated in high-volume hospitals compared to lower volume hospitals. However, the ideal threshold could not be determined. The association between trauma volume and other domains of the quality of healthcare remains unclear.

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Section: Resultsmentioning

confidence: 99%

Trauma Patient Volume and the Quality of Care: A Scoping Review

Foppen,

Claassen,

Falck

et al. 2023

JCM

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“…Moreover, it is important to provide high-quality trauma care to improve the mortality of patients with severe injuries. Several studies have reported that a higher hospital admission volumes resulted in lower mortality among severely injured patients because the increased volume of severely injured patients per hospital was correlated with an increased number of urgent procedures required for severely injured patients, such as blood transfusions, TAE and/or surgical intervention 20 21. Moreover, previous studies showed that patients with penetrating injuries had a survival benefit if they were centrally triaged to higher-level trauma centres 22.…”

Section: Discussionmentioning

confidence: 99%

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

Nagao,

Toida,

Morimura

2023

BMJ Open

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BackgroundUnintentional injury remains the leading cause of death among Japanese people younger than 35 years; however, data are limited on the evaluation of characteristics, long-term mortality trend and mortality risk of patients with penetrating injury in Japan. This prevents the development of effective strategies for trauma care in patients with penetrating injury.MethodsThis retrospective cohort study investigated 313 643 patients registered in the Japan Trauma Data Bank (JTDB) dataset between 1 January 2009 and 31 March 2018. The inclusion criteria comprised patients with penetrating injuries transferred from the injury site by emergency vehicles. Moreover, the patients registered in the JTDB dataset were included in this study regardless of age and sex. Outcomes measured were nationwide trends of characteristics, in-hospital mortality and in-hospital mortality risk among Japanese patients with penetrating injury. The mortality risk was analysed by hospital admission year, age, Injury Severity Score (ISS) and emergency procedures.ResultsOverall, 7132 patients were included. Median age significantly increased during the 10-year study periods (from 48 to 54 years, p=0.002). Trends for the mechanism of injury did not change; the leading cause of penetrating injury was stab wounds (SW: 76%–82%). Overall, the in-hospital mortality rate significantly decreased (4.0% to 1.7%, p=0.008). However, no significant improvement was observed in the in-hospital mortality trend in all ISS groups with SW and active bleeding. Patients with active bleeding who underwent urgent transcatheter arterial embolization had significantly lower mortality risk (p=0.043, OR=0.12, 95% CI=0.017 to 0.936). Conversely, the surgical procedure for haemostasis did not improve the mortality risk of patients with SW and active bleeding.ConclusionThe severity-adjusted mortality trend in patients with penetrating injuries did not improve. Moreover, patients with active bleeding who underwent urgent surgical procedure for haemostasis had a higher mortality risk.

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“…injured patients with ISS 0-15 and 16-25 was significantly lower than that of patients with ISS �16 (0.05 and 0.22 vs 1.00, p <0.001). The ISS cutoff value of ISS �16 has been commonly used as the definition of severe injury in Japanese trauma research [10][11][12]14]. However, it may be necessary to change the definition of severe injury to include those having ISS cutoff values of �26 instead of �16, since trauma mortality trend has decreased and OR for mortality of injured patients with ISS �26 was relatively higher than those of patients with ISS 0−15 and 16−25 in the past decades.…”

Section: Plos Onementioning

confidence: 99%

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

et al. 2022

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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.

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Correlation between Hospital Volume of Severely Injured Patients and In-Hospital Mortality of Severely Injured Pediatric Patients in Japan: A Nationwide 5-Year Retrospective Study

Cited by 4 publications

References 26 publications

Trauma Patient Volume and the Quality of Care: A Scoping Review

Trauma Patient Volume and the Quality of Care: A Scoping Review

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

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

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