Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Rapid identification of the severity of injuries in the field is important to ensure appropriate hospital care for better outcomes. Vital signs are used as a field triage tool for critically ill or injured patients in prehospital settings. Several studies have shown that recording vital signs, especially blood pressure, in pediatric patients is sometimes omitted in prehospital settings compared with that in adults. However, little is known about the association between the lack of measurement of prehospital vital signs and patient outcomes. In this study, we examined the association between the rate of vital sign measurements in the field and patient outcomes in injured children. METHODS: This study analyzed secondary data from the Japan Trauma Data Bank. We included pediatric patients (0-17 years) with injuries who were transported by emergency medical services. Hospital survival was the primary outcome. We performed a propensity-matched analysis with nearest-neighbor matching without replacement by adjusting for demographic and clinical variables to evaluate the effect of recording vital signs. RESULTS: During the study period, 13,413 pediatric patients were included. There were 9,187 and 1,798 patients with and without prehospital blood pressure records, respectively. After matching, there were no differences in the patient characteristics or disease severity. Hospital mortality was significantly higher in the non-recorded group than in the recorded group (4.3% vs. 1.1%; P < .001). The multiple logistic regression analysis results showed no prehospital record of blood pressure being associated with death (odds ratio [OR], 6.82; 95% confidence interval [CI], 2.40-19.33). Glasgow Coma Scale score and Injury Severity Score were also associated with death (OR, 0.71; 95% CI, 0.63- 0.81 and OR, 1.10; 95% CI, 1.06-11.14, respectively). CONCLUSIONS: Pediatric patients without any blood pressure records in prehospital settings had higher mortality rates than those with prehospital blood pressure records. LEVEL OF EVIDENCE: Therapeutic/Care Management IV.

DOI： 10.1097/TA.0000000000004114

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本外傷学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVES: The definition of severely injured patients lacks universal consensus based on quantitative measures. The most widely used definition of severe injury is based on the Injury Severity Score (ISS), which is calculated using the Abbreviated Injury Scale in Japan. This study aimed to compare the prevalence, in-hospital mortality and OR for mortality in patients with ISS ≥16, ISS ≥18 and ISS ≥26 by age groups. DESIGN: Retrospective cohort study. SETTING: Japan Trauma Data Bank, which is a nationwide trauma registry with data from 280 hospitals. PARTICIPANTS: We used data of 117 199 injured patients from a national database. We included injured patients who were transferred from the scene of injury by ambulance and/or physician. PRIMARY AND SECONDARY OUTCOME MEASURES: Prevalence, in-hospital mortality and OR for mortality with respect to age and injury level (ISS group). RESULTS: In all age categories, the in-hospital mortality of patient groups with an ISS ≥16, ISS ≥18 and ISS ≥26 was 13.3%, 17.4% and 23.5%, respectively. The in-hospital mortality for patients aged >75 years was the highest (20% greater than that of the other age groups). Moreover, in-hospital mortality for age group 5-14 years was the lowest (4.0-10.9%). In all the age groups, the OR for mortality for patients with ISS ≥16, ISS ≥18 and ISS ≥26 was 12.8, 11.0 and 8.4, respectively. CONCLUSIONS: Our results revealed the lack of an acceptable definition, with a high in-hospital mortality and high OR for mortality for all age groups.

DOI： 10.1136/bmjopen-2022-062619

PubMed

researchmap

Publishing type：Research paper (scientific journal)  

<h4>Background</h4>Emergency medical service (EMS) providers are the first medical professionals to make contact with patients in an emergency. However, the frequency of care by EMS providers for severely injured children is limited. Vital signs are important factors in assessing critically ill or injured patients in the prehospital setting. However, it has been reported that documentation of pediatric vital signs is sometimes omitted, and little is known regarding the performance rate of vital sign documentation by EMS providers in Japan. Using a nationwide data base in Japan, this study aimed to evaluate the relationship between patients' age and the documentation of vital signs in prehospital settings.<h4>Methods</h4>This study was a secondary data analysis of the Japan Trauma Data Bank. The inclusion criterion was patients with severe trauma, as defined by an Injury Severity Score ≥ 16. Our primary outcome was the rate of recording all four basic vital signs, namely blood pressure, heart rate, respiratory rate, and level of consciousness in the prehospital setting among different age groups. We also compared the prehospital vital sign completion rate, that is, the rate at which all four vital signs were recorded in a prehospital setting based on age groups. Multivariate analysis was performed to evaluate factors associated with the prehospital vital sign completion rate.<h4>Results</h4>We analyzed 75,777 severely injured patients. Adults accounted for 94% (71400) of these severely injured patients, whereas only 6% of patients were children. The rate of prehospital recording of vital signs was lower in children ≤5 years than in adult patients for all four vital signs. When the adult group was used as a reference, the adjusted odds ratios of vital sign completion rate in infants (0 years), younger children (1-5 years), older children (6-11 years), and teenagers (12-17 years) were 0.09, 0.30, 0.78, and 0.87, respectively.<h4>Conclusions</h4>Analysis of the nationwide trauma registry showed that younger children tended to have a lower rate of vital sign documentation in prehospital settings.

DOI： 10.1186/s12873-022-00725-2

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本救急医学会  

researchmap

Language：Japanese   Publisher：(一社)日本外傷学会  

researchmap

Language：Japanese   Publisher：(一社)日本小児救急医学会  

researchmap

Language：Japanese   Publisher：(一社)日本臨床救急医学会  

researchmap

Publishing type：Research paper (scientific journal)  

<h4>Background</h4>Computed tomography (CT) is often performed to assess patients; however, little is known about how airway size measured by CT scan imaging might influence the occurrence of post-extubation upper airway obstruction.<h4>Methods</h4>This study aimed to evaluate the association between airway size measured by CT and the incidence of post-extubation upper airway obstruction symptoms for each sex. This single-center observational study was conducted at a tertiary emergency medical center/severe trauma center with a 12-bed intensive care unit. We enrolled consecutive adult patients (aged ≥ 20 years), who were intubated in the emergency room, between January 2016 and March 2019. Patients who underwent a CT scan of the glottic region within three hours before and after intubation were included in the analysis. For each sex, we first divided the patients into two groups: those who had post-extubation stridor, hoarseness, or both and those who had no such symptoms. Then, we compared the two groups using the Mann-Whitney U test and Fisher's exact test. Univariate and multivariate logistic regression analyses were also performed.<h4>Results</h4>During the 39 months, 855 patients were enrolled in this study. A total of 217 patients underwent CT of the glottic region within three hours before and after intubation. Five patients had no records of symptoms after extubation. Thus, we analyzed data from 212 patients. This study included 144 males and 68 females. In female patients, the median [inter-quartile range] (average) of the transverse diameter of the glottis/endotracheal tube outer diameter (OD) ratio was smaller in patients with post-extubation upper airway obstruction symptoms than in patients without the symptoms (1.00 [1.00-1.00] (0.9572) vs. 1.00 [1.00-1.00] (1.00296), respectively; p = .013). Multivariate logistic regression analysis showed that the glottis/tube OD ratio < 1 was associated with the symptoms in females (odds ratio: 95% confidence interval, 5.68: 1.04-30.97). There was no relation between the airway sizes and the symptoms in male patients.<h4>Conclusions</h4>In female patients, no gap between the endotracheal tube and the vocal codes or the glottic transverse diameter being smaller than the endotracheal tube OD on CT scan was associated with post-extubation upper airway obstruction symptoms.

DOI： 10.1186/s12873-022-00615-7

PubMed

researchmap

Language：Japanese   Publisher：(公社)日本小児科学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

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.

DOI： 10.1371/journal.pone.0272573

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

Computed tomography (CT) scans are useful for confirming head injury diagnoses. However, there is no standard clinical decision rule (CDR) for determining the need for CT scanning in pediatric patients with head injuries. We developed a CDR and conducted a retrospective cohort study to evaluate its diagnostic accuracy in identifying children with clinically important traumatic brain injury (ciTBI). We selected predictors based on three existing CDRs: CATCH, CHALICE, and PECARN. Of the 2569 eligible patients, 645 (439 (68%) boys, median age: five years) were included in this study. In total, 59 (9%) patients showed ciTBI, and 129 (20%) were admitted to hospital. The novel CDR comprised six predictors of abnormal CT findings. It had a sensitivity of 79.5% (95% confidence interval (CI): 65.5-89.0%) and a specificity of 50.9% (95% CI: 48.9-52.3%). The area under the receiver-operating characteristic curve (0.72, 95% CI: 0.67-0.77) was non-inferior to those of CATCH, CHALICE, and PECARN (0.71, 95% CI: 0.66-0.77; 0.67, 95% CI: 0.61-0.74; and 0.69, 95% CI: 0.64-0.73, respectively; p = 0.57). The novel CDR was statistically noninferior in diagnostic accuracy compared to the three existing CDRs. Further development and validation studies are needed before clinical application.

DOI： 10.3390/jcm10225248

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本救急医学会  

researchmap

Language：Japanese   Publisher：(一社)日本集中治療医学会  

researchmap

Language：Japanese   Publisher：(一社)日本外傷学会  

researchmap

Language：Japanese   Publisher：(一社)日本外傷学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

Appropriate trauma care systems, suitable for children are needed; thus, this retrospective nationwide study evaluated the correlation between the annual total hospital volume of severely injured patients and in-hospital mortality of severely injured pediatric patients (SIPP) and compared clinical parameters and outcomes per hospital between low- and high-volume hospitals. During the five-year study period, we enrolled 53,088 severely injured patients (Injury Severity Score, ≥16); 2889 (5.4%) were pediatric patients aged <18 years. Significant Spearman correlation analysis was observed between numbers of total patients and SIPP per hospital (p < 0.001), and the number of SIPP per hospital who underwent interhospital transportation and/or urgent treatment was correlated with the total number of severely injured patients per hospital. Actual in-hospital mortality, per hospital, of SIPP patients was significantly correlated with the total number patients per hospital (p < 0.001,). The total number of SIPP, requiring urgent treatment, was higher in the high-volume than in the low-volume hospital group. No significant differences in actual in-hospital morality (p = 0.246, 2.13 (0-8.33) vs. 0 (0-100)) and standardized mortality ratio (SMR) values (p = 0.244, 0.31 (0-0.79) vs. 0 (0-4.87)) were observed between the two groups; however, the 13 high-volume hospitals had an SMR of <1.0. Centralizing severely injured patients, regardless of age, to a higher volume hospital might contribute to survival benefits of SIPP.

DOI： 10.3390/jcm10071422

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

Traumatic brain injury (TBI) is the major cause of mortality and morbidity in severely-injured patients worldwide. This retrospective nationwide study aimed to evaluate the age- and severity-related in-hospital mortality trends and mortality risks of patients with severe TBI from 2009 to 2018 to establish effective injury prevention measures. We retrieved information from the Japan Trauma Data Bank dataset between 2009 and 2018. The inclusion criteria for this study were patients with severe TBI defined as those with an Injury Severity Score ≥ 16 and TBI. In total, 31,953 patients with severe TBI (32.6%) were included. There were significant age-related differences in characteristics, mortality trend, and mortality risk in patients with severe TBI. The in-hospital mortality trend of all patients with severe TBI significantly decreased but did not improve for patients aged ≤ 5 years and with a Glasgow Coma Scale (GCS) score between 3 and 8. Severe TBI, age ≥ 65 years, fall from height, GCS score 3-8, and urgent blood transfusion need were associated with a higher mortality risk, and mortality risk did not decrease after 2013. Physicians should consider specific strategies when treating patients with any of these risk factors to reduce severe TBI mortality.

DOI： 10.3390/jcm10051072

PubMed

researchmap

Publishing type：Research paper (scientific journal)   Publisher：Public Library of Science ({PLoS})  

DOI： 10.1371/journal.pone.0246896

researchmap

Language：Japanese   Publisher：(公社)日本小児科学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: In-hospital mortality in trauma patients has decreased recently owing to improved trauma injury prevention systems. However, no study has evaluated the validity of the Trauma and Injury Severity Score (TRISS) in pediatric patients by a detailed classification of patients' age and injury severity in Japan. This retrospective nationwide study evaluated the validity of TRISS in predicting survival in Japanese pediatric patients with blunt trauma by age and injury severity. METHODS: Data were obtained from the Japan Trauma Data Bank during 2009-2018. The outcomes were as follows: (1) patients' characteristics and mortality by age groups (neonates/infants aged 0 years, preschool children aged 1-5 years, schoolchildren aged 6-11 years, and adolescents aged 12-18 years), (2) validity of survival probability (Ps) assessed using the TRISS methodology by the four age groups and six Ps-interval groups (0.00-0.25, 0.26-0.50, 0.51-0.75, 0.76-0.90, 0.91-0.95, and 0.96-1.00), and (3) the observed/expected survivor ratio by age- and Ps-interval groups. The validity of TRISS was evaluated by the predictive ability of the TRISS method using the receiver operating characteristic (ROC) curves that present the sensitivity, specificity, positive predictive value, negative predictive value, accuracy, area under the receiver operator characteristic curve (AUC) of TRISS. RESULTS: In all the age categories considered, the AUC for TRISS demonstrated high performance (0.935, 0.981, 0.979, and 0.977). The AUC for TRISS was 0.865, 0.585, 0.614, 0.585, 0.591, and 0.600 in Ps-interval groups (0.96-1.00), (0.91-0.95), (0.76. - 0.90), (0.51-0.75), (0.26-0.50), and (0.00-0.25), respectively. In all the age categories considered, the observed survivors among patients with Ps interval (0.00-0.25) were 1.5 times or more than the expected survivors calculated using the TRISS method. CONCLUSIONS: The TRISS methodology appears to predict survival accurately in Japanese pediatric patients with blunt trauma; however, there were several problems in adopting the TRISS methodology for younger blunt trauma patients with higher injury severity. In the next step, it may be necessary to develop a simple, high-quality prediction model that is more suitable for pediatric trauma patients than the current TRISS model.

DOI： 10.1186/s12873-020-00385-0

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本外傷学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: It remains unclear whether transcatheter arterial embolisation (TAE) is as safe and effective for paediatric patients with blunt torso trauma as it is for adults in Japan, owing to few trauma cases and sporadic case reports. The study aimed to compare the efficacy and safety of TAE performed in paediatric (age ≤ 15 years) and adult patients with blunt torso trauma. METHODS: This was a single-centre, retrospective chart review study that included blunt torso trauma patients who underwent TAE in the trauma centre from 2012 to 2017. The comparative study was carried out between a 'paediatric patient group' and an 'adult patient group'. The outcome measures for TAE were the success of haemorrhage control and complications and standardised mortality ratio (SMR). RESULTS: A total of 504 patients with blunt torso trauma were transported to the trauma centre, out of which 23% (N = 114) with blunt torso trauma underwent TAE, including 15 paediatric and 99 adult patients. There was no significant difference between the use of TAE in paediatric and adult patients with blunt torso trauma (29% vs 22%, P = .221). The paediatric patients' median age was 11 years (interquartile ranges 7-14). The predicted mortality rate and SMR for paediatric patients were lower than those for adult patients (18.3% vs 25.9%, P = .026, and 0.37 vs 0.54). The rate of effective haemorrhage control without repeated TAE or additional surgical intervention was 93% in paediatric patients, which was similar to that in adult patients (88%). There were no complications in paediatric patients at our centre. There were no significant differences in the proportion of paediatric patients who underwent surgery before TAE or urgent blood transfusion (33% vs 26%, P = .566, or 67% vs 85%, P = .084). CONCLUSIONS: It is possible to provide an equal level of care related to TAE for paediatric and adult patients as it relates to TAE for blunt torso trauma with haemorrhage in the trauma centre. Alternative haemorrhage control procedures should be established as soon as possible whenever the patients reach a haemodynamically unstable state.

DOI： 10.1186/s12873-020-00381-4

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

This study investigated the risk factors for in-hospital mortality of severe blunt trauma patients who underwent transcatheter arterial embolization (TAE). We analysed data from the Japan Trauma Data Bank from 2009 to 2018. Patients with severe blunt trauma and an Injury Severity Score (ISS) ≥ 16 who underwent TAE were enrolled. The primary analysis evaluated patient characteristics and outcomes, and variables with significant differences were included in the secondary multivariate logistic regression analysis. In total, 5800 patients (6.4%) with ISS ≥ 16 underwent TAE. There were significant differences in the proportion of male patients, transportation method, injury mechanism, injury region, Revised Trauma Score, survival probability values, and those who underwent urgent blood transfusion and additional urgent surgery. In multivariable regression analyses, higher age, urgent blood transfusion, and initial urgent surgery were significantly associated with higher in-hospital mortality risk [p < 0.001, odds ratio (OR), 95% confidence interval (CI): 1.01 (1.00-1.01); p < 0.001, 3.50 (2.55-4.79); and p = 0.001, 1.36 (1.13-1.63), respectively]. Inter-hospital transfer was significantly associated with lower in-hospital mortality risk (p < 0.001, OR = 0.56, 95% CI = 0.44-0.71). Treatment protocols for urgent intervention before and after TAE and a safe, rapid inter-hospital transport system are needed to improve mortality risks for severe blunt trauma patients.

DOI： 10.3390/jcm9113485

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

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.

DOI： 10.3390/jcm9103273

PubMed

researchmap

Publishing type：Research paper (scientific journal)   Publisher：{SAGE} Publications  

DOI： 10.1177/0300060520926367

researchmap

Language：Japanese   Publisher：日本救急医学会-関東地方会  

researchmap

Language：Japanese   Publisher：日本救急医学会-関東地方会  

researchmap

Language：Japanese   Publisher：日本救急医学会-関東地方会  

researchmap

Language：English  

BACKGROUND: Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is one of the ultimate treatments for acute respiratory failure. However, the effectiveness of ECMO in patients with novel coronavirus disease (COVID-19) is unknown. CASE PRESENTATION: A 72-year-old woman who was a passenger of a cruise ship tested positive for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) while in quarantine on board using throat swab. Three days after admission, her condition deteriorated, and she was subsequently intubated. On day 6, VV-ECMO was introduced. Lopinavir/ritonavir was given; continuous renal replacement therapy was also introduced. On day 10, her chest radiography and lung compliance improved. She was weaned off ECMO on day 12. CONCLUSION: Treatment of severe pneumonia in COVID-19 by ECMO should recognize lung plasticity considering time to ECMO introduction and interstitial biomarkers. In Japan, centralization of ECMO patients has not been sufficient. Thus, we suggest nationwide centralization and further research to respond to the crisis caused by COVID-19.

DOI： 10.1002/ams2.509

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本救急医学会  

researchmap

Language：Japanese   Publisher：(一社)日本救急医学会  

researchmap

Language：Japanese   Publisher：(一社)日本救急医学会  

researchmap

Language：Japanese   Publisher：(一社)日本救急医学会  

researchmap

Language：Japanese   Publisher：(一社)日本小児救急医学会  

researchmap

Language：Japanese   Publisher：(一社)日本小児救急医学会  

researchmap

Language：Japanese   Publisher：日本救急医学会-関東地方会  

researchmap

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J01057&link_issn=&doc_id=20190813260003&doc_link_id=10.24697%2Fjaamkanto.40.2_205&url=https%3A%2F%2Fdoi.org%2F10.24697%2Fjaamkanto.40.2_205&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：Japanese   Publisher：(一社)日本外傷学会  

researchmap

Language：Japanese   Publisher：(一社)日本外傷学会  

researchmap

Language：Japanese   Publisher：(一社)日本臨床救急医学会  

researchmap

Language：Japanese   Publisher：(一社)日本集中治療医学会  

researchmap

Language：Japanese   Publisher：(一社)日本集中治療医学会  

researchmap

Language：Japanese   Publisher：(公社)日本小児科学会  

researchmap

Language：Japanese   Publisher：(公社)日本小児科学会  

researchmap

Language：Japanese   Publisher：(公社)日本小児科学会  

researchmap

Language：Japanese   Publisher：日本救急医学会-関東地方会  

researchmap

Language：Japanese   Publisher：日本救急医学会-関東地方会  

researchmap

Language：Japanese   Publisher：日本救急医学会-関東地方会  

researchmap

Language：English  

Foreign body asphyxia is a serious clinical problem with high morbidity and mortality rates. It is relatively common among children, especially those younger than 3 years, because they have a high risk of aspirating foreign bodies owing to their tendency to place objects in their mouth and lack of a well-developed swallowing reflex. Moreover, the neurologic outcome after out-of-hospital cardiac arrests (OHCA) in pediatric patients remains generally poor. Here, we report an unusual pediatric case of asphyxial OHCA caused by foreign bodies obstructing the airway, complicating esophageal foreign body, with a neurologically favorable outcome. This case highlights the importance of adequate treatment for pediatric patients with OHCA, as well as the prompt and efficient management for pediatric patients with foreign bodies obstructing the airway and esophagus.

DOI： 10.1155/2019/6858171

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

INTRODUCTION: It remains unclear whether trauma centers are effective for the treatment of injured pediatric patients. The aim of this study was to evaluate children's mortality before and after the establishment a trauma center by using standard mortality ratios (SMR) and a modified observed-expected chart. METHODS: This was a single center, retrospective chart review study that included injured pediatric patients (age <16 years) who were transported to our trauma center by the emergency medical services from 2012 to 2016 in Japan. RESULTS: Our study included 143 subjects: 45 (31%) were preschoolers aged < 6 years, and 43 (30%) had an injury severity score (ISS) ≥ 16. After the trauma centers established, the number of patients increased (70% increase per month), as did the number of the patients with an ISS of 41-75. The percentage of indirect transportations was significantly higher in the trauma center than in the non-trauma center (49% vs. 28%; p < 0.05). The SMR was significantly lower in the trauma-center than in the non-trauma center (0.461 vs. 0.589; p < 0.05). The mean value of the modified observed-expected chart was significantly higher in the trauma-center than in the non-trauma center (4.6 vs. 2.3; p < 0.05). For the patients who were directly transferred to our center, the transfer distance was greater in the trauma-center than in the non-trauma center (6.8 vs. 6.2 km; p < 0.05). The time interval from hospital admission to initiation of computed tomography (15.5 vs. 33 minutes; p < 0.05) and to definitive care (44 vs. 64.5 minutes; p < 0.05) decreased in the after group compared to the non-trauma center. CONCLUSIONS: The results of our study revealed that the centralization of pediatric injured pediatric patients in trauma centers improved the mortality rate in this population in Japan.

DOI： 10.1371/journal.pone.0217140

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本救急医学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

AIM: Capillary refill time has been widely adopted for clinical assessment of the circulatory status of patients in emergency settings. We previously introduced quantitative capillary refill time and found a positive association between longer quantitative capillary refill time and higher lactate levels in the intensive care units, but not in the emergency department. In this study, we aimed to identify a quantitative and clinically applicable index of circulatory status (ΔA b) that can be measured with quantitative capillary refill time, then evaluated the linear association between this index and lactate levels in the emergency department. METHODS: We undertook a prospective single-center observational study at a university hospital from November 2015 to July 2016. We included 139 patients with endogenous diseases to test the association between quantitative capillary refill time, ΔA b (measured with a pulse oximeter), and lactate levels. RESULTS: ΔA b was independently and significantly associated with high lactate levels (odds ratio [95% confidence interval]: 0.16 [0.05-0.45]). CONCLUSIONS: We introduced ΔA b, measured using quantitative capillary refill time, as a surrogate index of lactate levels to overcome the shortcomings of capillary refill time. We showed that ΔA b is a feasible, non-invasive, and rapid assessment of patients with high lactate levels in emergency primary care settings. Future multicenter studies with a longitudinal design should be undertaken to verify our findings.

DOI： 10.1002/ams2.348

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本救急医学会  

researchmap

Language：Japanese   Publisher：(一社)日本救急医学会  

researchmap

Language：Japanese   Publisher：(一社)日本外傷学会  

researchmap

Language：Japanese   Publisher：(一社)日本外傷学会  

researchmap

Language：Japanese   Publisher：(一社)日本蘇生協議会  

researchmap

Language：Japanese   Publisher：(一社)日本臨床救急医学会  

researchmap

Language：Japanese   Publisher：(一社)日本臨床救急医学会  

researchmap

Language：Japanese   Publisher：(一社)日本臨床救急医学会  

researchmap

Language：Japanese   Publisher：(一社)日本小児救急医学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Triage has an important role in providing suitable care to the largest number of casualties in a disaster setting, but there are no secondary triage methods suitable for children. This study developed a new secondary triage method named the Pediatric Physiological and Anatomical Triage Score (PPATS) and compared its accuracy with current triage methods. METHODS: A retrospective chart review of pediatric patients under 16 years old transferred to an emergency center from 2014 to 2016 was performed. The PPATS categorized the patients, defined the intensive care unit (ICU)-indicated patients if the category was highest, and compared the accuracy of prediction of ICU-indicated patients among PPATS, Physiological and Anatomical Triage (PAT), and Triage Revised Trauma Score (TRTS). RESULTS: Among 137 patients, 24 (17.5%) were admitted to ICU. The median PPATS score of these patients was significantly higher than that of patients not admitted to ICU (11 [IQR: 9-13] versus three [IQR: 2-4]; P<.001). The optimal cut-off value of the PPTAS was six, yielding a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 95.8%, 86.7%, 60.5%, and 99.0%. The area under the receiver-operating characteristic curve (AUC) was larger for PPTAS than for PAT or TRTS (0.95 [95% CI, 0.87-1.00] versus 0.65 [95% CI, 0.58-0.72]; P<.001 and 0.79 [95% CI, 0.69-0.89]; P=.003, respectively). Regression analysis showed a significant association between the PPATS and the predicted mortality rate (r2=0.139; P<.001), ventilation time (r2=0.320; P<.001), ICU stay (r2=0.362; P<.001), and hospital stay (r2=0.308; P<.001). CONCLUSIONS: The accuracy of PPATS was superior to other methods for secondary triage of children. Toida C , Muguruma T , Abe T , Shinohara M , Gakumazawa M , Yogo N , Shirasawa A , Morimura N . Introduction of pediatric physiological and anatomical triage score in mass-casualty incident. Prehosp Disaster Med. 2018;33(2):147-152.

DOI： 10.1017/S1049023X18000109

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本集中治療医学会  

researchmap

Language：Japanese   Publisher：(公社)日本小児科学会  

researchmap

Language：Japanese   Publisher：日本救急医学会-関東地方会  

researchmap

Language：Japanese   Publisher：日本救急医学会-関東地方会  

researchmap

Language：Japanese   Publisher：日本救急医学会-関東地方会  

researchmap

Language：Japanese   Publisher：日本救急医学会-関東地方会  

researchmap

Language：Japanese   Publisher：日本救急医学会-関東地方会  

researchmap

Language：Japanese   Publisher：日本救急医学会-関東地方会  

researchmap

Language：Japanese   Publisher：日本救急医学会-関東地方会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVES: The purpose of the current study was to assess our multidisciplinary approach consisting of early application of neurology-oriented intensive care, aggressive artificial liver support and liver transplantation at the appropriate time for infants with acute liver failure. DESIGN: Retrospective cohort study. SETTING: A tertiary pediatric medical center in Japan. PATIENTS: Seventeen infants younger than 12 months with acute liver failure who subsequently underwent liver transplantation between February 2006 and June 2011. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The patients varied from 1 to 11 months, with a median of 6 months. The median body weight was 8.0 kg (range, 2.7-10 kg). With respect to the encephalopathy grading before liver transplantation, four cases were categorized as grade II, seven cases were categorized as grade III, and five cases were categorized as grade IV. Continuous veno-venous hemodiafiltration and plasma exchange were applied to all the infants until liver transplantation. Bilirubin, ammonia, prothrombin time/international normalized ratio and creatinine decreased significantly after continuous veno-venous hemodiafiltration + plasma exchange (p < 0.001). The median value of catecholamine index changed from 10 to 0 (range, 0-20.6). Notably, among the 16 infants who underwent electroencephalography assessment, five did not show slow waves throughout their stay, and one who did so before treatment ceased to show any after treatment. The all patients underwent living-donor liver transplantation and were subsequently discharged from the PICU. The overall survival rate was 88% (15/17) with a median follow-up period of 28 months (range, 2-64 mo). Regarding the neurological outcomes of the survivors, 73% (11/15) had no neurological morbidities and 20% (3/15) had mild disabilities. CONCLUSIONS: Our multidisciplinary approach for infants with acute liver failure achieved favorable outcomes. Further investigations are needed to examine the efficacy of the artificial liver support.

DOI： 10.1097/PCC.0000000000000511

PubMed

researchmap

Language：Japanese   Publisher：(公社)日本小児科学会  

researchmap

Language：Japanese   Publisher：(一社)日本臨床救急医学会  

DOI： 10.11240/jsem.17.414

researchmap

Language：Japanese   Publisher：Japanese Society for Emergency Medicine  

DOI： 10.11240/jsem.17.656

researchmap

DOI： 10.3918/jsicm.21.359

researchmap

Language：Japanese   Publisher：(一社)日本小児救急医学会  

researchmap

DOI： 10.3893/jjaam.25.814

researchmap

Language：Japanese   Publisher：(公社)日本小児科学会  

researchmap

Language：Japanese   Publisher：(公社)日本小児科学会  

researchmap

Language：Japanese   Publisher：日本救急医学会-関東地方会  

researchmap

Language：Japanese   Publisher：(一社)日本救急医学会  

researchmap

Language：Japanese   Publisher：(一社)日本救急医学会  

researchmap

Language：Japanese   Publisher：(一社)日本小児救急医学会  

researchmap

Language：Japanese   Publisher：(一社)日本外傷学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本外傷学会  

researchmap

Language：Japanese   Publisher：(一社)日本集中治療医学会  

researchmap

Language：Japanese   Publisher：(一社)日本救急医学会  

researchmap

Language：Japanese   Publisher：(一社)日本救急医学会  

researchmap

Language：Japanese   Publisher：(一社)日本救急医学会  

researchmap

Language：Japanese   Publisher：(一社)日本救急医学会  

researchmap

Language：Japanese   Publisher：(一社)日本外傷学会  

researchmap

Language：Japanese   Publisher：(一社)日本臨床救急医学会  

researchmap

Language：Japanese   Publisher：(一社)日本小児救急医学会  

researchmap

Language：Japanese   Publisher：(一社)日本小児救急医学会  

researchmap

Language：Japanese   Publisher：(一社)日本小児救急医学会  

researchmap

Language：Japanese   Publisher：(一社)日本小児救急医学会  

researchmap

Language：Japanese   Publisher：(一社)日本集中治療医学会  

researchmap

Language：Japanese   Publisher：(公社)日本小児科学会  

researchmap

Language：Japanese   Publisher：(公社)日本小児科学会  

researchmap

Language：Japanese   Publisher：(公社)日本小児科学会  

researchmap

Language：Japanese   Publisher：(一社)日本集中治療医学会  

researchmap

Language：Japanese  

J-GLOBAL

researchmap

Language：Japanese  

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

Language：Japanese  

The role of apheresis in the treatment for pediatric sepsis is unclear. There are not enough experience and evidence, because of the less incidence of pediatric sepsis and the infrequent introduction of apheresis for sepsis. The differences between adult and pediatric apheresis are small physical size and the variation of physical size. Because of small physical size, the importance of blood access and keeping warm are higher. Because of the variation of physical size from neonate to adolescent, it is very important to choose the appropriate size of catheter and membrane. Safe pediatric apheresis is very complex and it is necessary to devise the treatment very carefully, so cases should be aggregated to tertiary medical centers. From now, it is necessary to put children with severe sepsis into the tertiary centers and induct prospective studies for making the role of apheresis for pediatric sepsis clear.

CiNii Books

researchmap

Other Link： http://id.nii.ac.jp/1141/00151614/

J-GLOBAL

researchmap

Language：Japanese   Publisher：医学図書出版(株)  

researchmap