Ten-Year in-Hospital Mortality Trends among Paediatric Injured Patients in Japan: A Nationwide Observational Study

Abstract

Injury is a major cause of worldwide child mortality. This retrospective nationwide study aimed to evaluate the characteristics of paediatric injured patients in Japan and their in-hospital mortality trends from 2009 to 2018. Injured patients aged <17 years were enrolled. Data were extracted from the Japan Trauma Data Bank. In the Cochran-Armitage test, in-hospital mortality significantly decreased during the study period (p < 0.001), except among patients <1 year old, and yearly reductions were observed among those with an Injury Severity Score ≥16 and survival rate ≥50% (p < 0.001). In regression analyses, patients who underwent urgent blood transfusion within 24 h after hospital admission (odds ratio (OR) = 3.24, 95% confidence interval (CI) = 2.38–4.41) had a higher in-hospital mortality risk. Higher survival probability as per the Trauma and Injury Severity Score was associated with lower in-hospital mortality (OR = 0.92, 95% CI = 0.91–0.92), a risk which decreased from 2009 to 2018 (OR = 6.16, 95% CI = 2.94–12.88). Based on our results, there is a need for improved injury surveillance systems for establishment of injury prevention strategies along with evaluation of the quality of injury care and outcome measures.

Factors Affecting Death and Severe Injury in Child Motor Vehicle Passengers

“…Therefore, analyses using this database can provide useful evidence for prevention of injury. Two previous reports used the JTDB for investigating child injuries [25,26]. One of these studies focused on child injuries due to MVCs and described the injury patterns and outcomes relating to the seating position of the vehicle.…”

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

“…There were significant differences in the mortality risk of injured patients according to the severity of anatomical injury. Previous studies have shown that the mortality of injured patients with ISS ≥16 has been decreasing to below 20% [ 9 – 11 , 13 ]. This study also showed that the mortality rate of injured patients with ISS 0–15 and 16–25 in 2018 was 20% or less, regardless of age, injury mechanism, and injury region.…”

“…In patients aged younger than 15 years, the mortality trend in injured patients with ISS ≥26 did not significantly improve, and the in-hospital mortality risk of patient aged 0−4 years with ISS ≥26 remained high during the 10 years of study (26.1%−58.3%). Previous studies suggested that injured patients younger than 5 years had a higher mortality risk, because they included a high proportion of severe head injuries [ 11 , 15 ]. Our results also showed that the OR for mortality in patients with head injury and AIS ≥3 was 3.48.…”

“…As the ISS score is calculated based on an anatomical injury severity and correlates well with the mortality of injured patients, an ISS cutoff value of �16 was chosen as the definition of severe injury with high mortality risk based on the Major Trauma Outcome Study (MTOS) from 1982 to 1987, because patients with ISS �16 had an expected mortality rate of more than 20% [6][7][8][9]. Epidemiological trauma outcome research based on the JTDB data also frequently used an ISS cutoff value of �16 as the definition of severe injury [10][11][12].…”

“…The mortality of patients with trauma has decreased in recent years due to the development of the trauma care system [9][10][11]. Moreover, the mortality trend and risk of severely injured patients vary widely according to age, injury mechanism, injury region, and/or injury severity [3,[10][11][12][13].…”