Timing of computed tomography imaging in adult patients with severe trauma: A nationwide cohort study in Japan.

PURPOSE: Computed tomography (CT) has become essential for the management of trauma patients. However, appropriate timing of CT acquisition remains undetermined. The purpose of this study was to assess the relationship between time to CT acquisition and mortality among adult patients with severe trauma. METHODS: We conducted a retrospective cohort study using data from the Japan Trauma Data Bank, which had 256 participating institutions from all over Japan between 2004 and 2018. Patients were categorized upon arrival as either severe trunk trauma with signs of shock or severe head trauma with coma and separately analyzed. Cases were further divided into three groups based on time elapsed between arrival at hospital and CT acquisition as immediate (0-29 min), intermediate (30-59 min), or late (≥60 min). Primary outcome was mortality on discharge, and multivariate logistic regression with adjusting for confounders was used for evaluation. RESULTS: A total of 8467 (3640 in immediate group, 3441 in intermediate group, 1386 in late group) with trunk trauma patients and 6762 (4367 in immediate group, 2031 in intermediate group, 364 in late group) with head trauma patients were eligible for analysis included in the trunk and head trauma groups, respectively. The trunk trauma patients with shock on hospital arrival was 56.4% (4773/8467), and the head trauma patients with deep coma upon EMS arrival was 44.2% (2988/6762). Mortality rate gradually increased from 5.7% to 15.8% with prolonged time to CT imaging among trunk trauma patients. Multivariate logistic regression for death on discharge among trunk trauma patients yielded an adjusted odds ratio of 1.79 (95% confidence interval: 1.42-2.27) for the late group compared to the immediate group. In contrast, among head trauma patients, an adjusted odds ratio was 0.93 (95% confidence interval: 0.71-1.20) for the late group compared to the immediate group. CONCLUSION: CT scan at or after 60 min was associated with increased death on discharge among patients with severe trunk trauma but not in those with severe head trauma.

Gut Dysbiosis Associated with Antibiotics and Disease Severity and Its Relation to Mortality in Critically Ill Patients.

BACKGROUND: The gut microbiota are reported to be altered in critical illness. The pattern and impact of dysbiosis on prognosis has not been thoroughly investigated in the ICU setting. AIMS: We aimed to evaluate changes in the gut microbiota of ICU patients via 16S rRNA gene deep sequencing, assess the association of the changes with antibiotics use or disease severity, and explore the association of gut microbiota changes with ICU patient prognosis. METHODS: Seventy-one mechanically ventilated patients were included. Fecal samples were collected serially on days 1-2, 3-4, 5-7, 8-14, and thereafter when suitable. Microorganisms of the fecal samples were profiled by 16S rRNA gene deep sequencing. RESULTS: Proportions of the five major phyla in the feces were diverse in each patient at admission. Those of Bacteroidetes and Firmicutes especially converged and stabilized within the first week from admission with a reduction in α-diversity (p < 0.001). Significant differences occurred in the proportional change of Actinobacteria between the carbapenem and non-carbapenem groups (p = 0.030) and that of Actinobacteria according to initial SOFA score and changes in the SOFA score (p < 0.001). An imbalance in the ratio of Bacteroidetes to Firmicutes within seven days from admission was associated with higher mortality when the ratio was > 8 or < 1/8 (odds ratio: 5.54, 95% CI: 1.39-22.18, p = 0.015). CONCLUSIONS: Broad-spectrum antibiotics and disease severity may be associated with gut dysbiosis in the ICU. A progression of dysbiosis occurring in the gut of ICU patients might be associated with mortality.

Synbiotics modulate gut microbiota and reduce enteritis and ventilator-associated pneumonia in patients with sepsis: a randomized controlled trial.

BACKGROUND: Commensal microbiota deteriorate in critically ill patients. The preventive effects of probiotic/synbiotic therapy on microbiota and septic complications have not been thoroughly clarified in patients with sepsis. The objective of this study was to evaluate whether synbiotics have effects on gut microbiota and reduce complications in mechanically ventilated patients with sepsis. METHODS: Sepsis patients who were mechanically ventilated in the intensive care unit (ICU) were included in this randomized controlled study. Patients receiving daily synbiotics (Bifidobacterium breve strain Yakult, Lactobacillus casei strain Shirota, and galactooligosaccharides) initiated within 3 days after admission (the Synbiotics group) were compared with patients who did not receive synbiotics (the No-Synbiotics group). The primary outcome was infectious complications including enteritis, ventilator-associated pneumonia (VAP), and bacteremia within 4 weeks from admission. The secondary outcomes included mortality within 4 weeks, fecal bacterial counts, and organic acid concentration. Enteritis was defined as the acute onset of continuous liquid stools for more than 12 h. RESULTS: Seventy-two patients completed this trial; 35 patients received synbiotics and 37 patients did not receive synbiotics. The incidence of enteritis was significantly lower in the Synbiotics than the No-Synbiotics group (6.3% vs. 27.0%; p < 0.05). The incidence of VAP was also significantly lower in the Synbiotics than the No-Synbiotics group (14.3% vs. 48.6%; p < 0.05). The incidence of bacteremia and mortality did not differ significantly between the two groups. In the analysis of fecal bacteria, the number of Bifidobacterium and Lactobacillus in the Synbiotics group was significantly higher than that in the No-Synbiotics group. In the analysis of fecal organic acids, total organic acid concentration, especially the amounts of acetate, were significantly greater in the Synbiotics group than in the No-Synbiotics group at the first week (p < 0.05). CONCLUSIONS: Prophylactic synbiotics could modulate the gut microbiota and environment and may have preventive effects on the incidence of enteritis and VAP in patients with sepsis. TRIAL REGISTRATION: UMIN, R000007633 . Registered on 29 September 2011.

Association of prophylactic synbiotics with reduction in diarrhea and pneumonia in mechanically ventilated critically ill patients: A propensity score analysis.

INTRODUCTION: The preventive association of synbiotics therapy has not been thoroughly clarified in mechanically ventilated patients. The purpose of this study was to evaluate whether synbiotics therapy has preventive association against septic complications in ventilated critically ill patients. METHODS: Critically ill patients who were mechanically ventilated were included in this retrospective observational study. Patients who received synbiotics (Bifidobacterium breve, Lactobacillus casei, and galactooligosaccharides) within 3 days after admission (denoted as synbiotics group) were compared with patients who did not receive synbiotics. The incidences of enteritis, pneumonia, and bacteremia were evaluated as clinical outcome. Enteritis was defined as an acute onset of diarrhea consisting of continuous liquid watery stools for more than 12 h. The confounding factors include APACHE II on admission, gender, the cause of admission and antibiotics. RESULTS: We included 179 patients in this study: 57 patients received synbiotics and 122 patients did not receive synbiotics. The incidences of enteritis were significantly lower in the synbiotics group compared with the control group (3.5% vs. 15.6%; p < 0.05). The odds ratios for diarrhea-free days during the first 28 days for the synbiotics group as compared with the controls were 4.354 (95% confidence interval (CI), 2.407 to 7.877; p < 0.001) in an ordinal logistic regression model with propensity scores. The odds ratios for pneumonia-free days during the first 28 days for the synbiotics group were 2.529 (95% CI, 1.715 to 3.731; p < 0.001). The incidences of bacteremia did not have significant differences. CONCLUSION: Prophylactic synbiotics appeared to have preventive association on enteritis and pneumonia in mechanically ventilated critically ill patients.

Metagenomic Analysis Reveals Dynamic Changes of Whole Gut Microbiota in the Acute Phase of Intensive Care Unit Patients.

BACKGROUND: Metagenomic analysis targeting the 16S rRNA gene has made it possible to characterize the vast array of microorganisms contained in the gut. AIM: The purpose of this study was to evaluate how gut microbiota change in intensive care unit (ICU) patients in the acute phase after admission. METHODS: This prospective observational cohort study investigated 12 patients admitted to a single ICU of a large urban tertiary referral hospital. All patients were mechanically ventilated on admission. Fecal samples were collected from patients on days 1-2, 2-4, 5-8, and 7-10 after admission. DNA was extracted from fecal samples, and 16S rRNA deep sequencing was performed to monitor gut changes. RESULTS: Bacteria belonging to the phyla Firmicutes or Bacteroidetes were predominant in each sample. We observed serial dynamic changes in the percentages of Bacteroidetes and Firmicutes that were significantly altered during study period (p < 0.05). A ratio of Bacteroidetes to Firmicutes (B/F ratio) of >10 was seen in four of the six patients who died, whereas a B/F ratio of <0.10 was seen in only one of the six deaths. None of the survivors had a B/F ratio of >10 or <0.10. There was a statistical difference in the B/F ratio between the dead patients and survivors (p = 0.022). CONCLUSIONS: Dynamic changes in gut microbiota at the phylum level of ICU patients during the acute phase were identified by high-throughput DNA sequencing. An extreme imbalance in gut microbiota may be associated with prognosis in critically ill patients.

Necrotizing soft tissue infection caused by Serratia marcescens: A case report and literature review.

A 64-year-old man with advanced liver cirrhosis was transferred to an emergency center due to septic shock and markedly inflamed left leg. Under a clinical diagnosis of necrotizing soft tissue infection (NSTI), the patient undertook intensive therapy but died 25 h after arrival. The pathogenic organism, Serratia marcescens, was later isolated from blood and soft tissue cultures. NSTI is very rarely associated with S. marcescens. A literature review showed that only 16 such cases, including our case, have been reported to date. Our case is the first evidence of an S. marcescens NSTI in a patient with liver cirrhosis. S. marcescens NSTI has an extremely high mortality rate; total mortality and mortality in cases involving the extremities were 75% (12 of 16 cases) and 83.3% (10 of 12 cases), respectively. Physicians need to be aware that S. marcescens can induce fatal infections in community patients.

Impact of pre-existing medical conditions on mortality in geriatric trauma: a nationwide study in Japan.

PURPOSE: To investigate the relationship between pre-existing medical conditions and outcomes in elderly trauma patients in Japan. METHODS: This multicenter observational study utilized data from the Japan Trauma Data Bank (JTDB) from 2019 to 2020. The primary outcome was in-hospital mortality. Factors associated with in-hospital mortality were identified using multivariate logistic regression analysis, from which adjusted odds ratios (AOR) and 95% confidence intervals (CI) were determined. RESULTS: Of the participants during the study period, 19,598 patients were included in the analysis. Among the pre-existing medical conditions, moderate or severe liver disease showed the strongest positive association with in-hospital mortality (AOR: 7.087, 95% CI: 3.194-15.722), followed by multiple malignancies (AOR: 3.490, 95% CI: 1.046-11.641), congestive heart failure (AOR: 2.572, 95% CI: 1.920-3.445), and moderate or severe renal disease (AOR: 2.256, 95% CI: 1.584-3.215). CONCLUSION: Data from JTDB suggests that pre-existing conditions like moderate or severe liver disease, congestive heart failure, and moderate or severe renal disease in elderly trauma patients are positively correlated with in-hospital mortality.

Effects of Concomitant Traumatic Spinal Cord and Brain Injury on In-Hospital Mortality: A Retrospective Analysis of a Nationwide Trauma Registry in Japan.

Isolated traumatic spinal cord injury (t-SCI) and traumatic brain injury (TBI) represent significant public health concerns, resulting in long-term disabilities and necessitating sophisticated care, particularly when occurring concurrently. The impact of these combined injuries, while crucial in trauma management, on clinical, socioeconomic, and health care outcomes is largely unknown. To address this gap, our secondary retrospective cohort study used data from the Japan Trauma Data Bank, covering patients enrolled over a 13-year period (2006-2018), to elucidate the effects of concurrent t-SCI and TBI on in-hospital mortality. Data on patient demographics, injury characteristics, treatment modalities, and outcomes were analyzed. Multivariate logistic regression analysis was performed to examine prognostic variables associated with in-hospital mortality, including interaction terms between t-SCI severity and TBI presence. This study included 91,983 patients with neurotrauma, with a median age of 62 years (69.7% men). Among the patients, 9,018 (9.8%) died in the hospital. Concomitant t-SCI and TBI occurred in 2,954 (3.2%) patients. t-SCI only occurred in 9,590 (10.4%) patients, whereas TBI only occurred in the majority of these cases (79,439, 86.4%). Multivariate logistic regression analysis revealed age; sex; total number of comorbidities; systolic blood pressure at presentation; Glasgow coma scale score at presentation; and Abbreviated Injury Scale (AIS) scores for head, face, chest, abdomen, cervical-SCI, thoracic-SCI, and lumbar-SCI as significant independent factors for in-hospital mortality. The odds ratio of cervical-SCI × head AIS as an interaction term was 0.85 (95% confidence interval: 0.77-0.95), indicating a negative interaction. In conclusion, we identified 12 factors associated with in-hospital mortality in patients with t-SCI. In addition, the negative interaction between cervical t-SCI and TBI suggests that the presence of t-SCI in patients with TBI may be underestimated. This study highlights the importance of early recognition and comprehensive management of these complex trauma conditions while considering the possibility of concomitant t-SCI in patients with TBI.

Characteristics and outcomes of severe sports-related injury in children and adults: a nationwide cohort study in Japan.

PURPOSE: Understanding epidemiological patterns in patients with severe sports-related injuries between children and adults is important for injury prevention. We ought to describe the characteristics and outcomes of patients with severe sports-related injuries and compare the characteristics between children and adults. METHODS: We conducted a retrospective analysis of the Japan Trauma Data Bank (JTDB). We included patients with sports-related injury and an ISS of at least 16, who were admitted between 2004 and 2018. We compared characteristics between children (< 18 years) and adults (≥ 18 years). We performed a multivariable logistic regression analysis to compare in-hospital mortality. RESULTS: We identified 1369 eligible patients (children, n = 326; adults, n = 1043). The most common season was April-June and July-September in children (28.5% and 27.9%) and January-March in adults (42.1%). Injuries to the head/neck (58.9% vs. 40.8%, p < 0.001) and abdomen (16.0% vs. 8.3%, p < 0.001) were significantly more frequent in children than adults, while injuries to the thorax (8.0% vs. 27.2%, p < 0.001), pelvis/lower extremity (0.6% vs. 6.0%, p < 0.001), and spine (23.9% vs. 35.3%, p < 0.001) were less frequent in children. We did not observe a statistically significant difference in in-hospital mortality between children and adults. CONCLUSIONS: We conducted a comprehensive analysis of severe sports-related injuries using a nationwide trauma database and demonstrated different patterns of severe sports-related injuries in children and adults.

Trends and characteristics of severe road traffic injuries in children: a nationwide cohort study in Japan.

PURPOSE: The purpose of this study was to evaluate temporal trends of characteristics of severe road traffic injuries in children and identify factors associated with mortality using a nationwide database in Japan. METHODS: We performed a retrospective analysis of Japan Trauma Data Bank (JTDB) from 2004 to 2018. We included patients with traffic injuries under the age of 18 who were hospitalized. The primary outcome was in-hospital mortality. We evaluated trends in characteristics and assessed factors associated with in-hospital mortality using a logistic regression analysis. RESULTS: A total of 4706 patients were analyzed. The most common mechanism of injury was bicycle crash (34.4%), followed by pedestrian (28.3%), and motorcycle crash (21.3%). The overall in-hospital mortality was 11.2%. We found decreasing trends in motorcycle crash and in-hospital mortality and increasing trends in rear passenger seats in cars over the 15-year period. The following factors were associated with in-hospital mortality: car crash (aOR 1.69, 95%CI 1.18-2.40), pedestrian (aOR 1.50, 95%CI 1.13-1.99), motorcycle crash (aOR 1.42, 95%CI 1.03-1.95) [bicycle crash as a reference]; concomitant injuries to head/neck (aOR 5.06, 95%CI 3.81-6.79), thorax (aOR 2.34, 95%CI 1.92-2.87), abdomen (aOR 1.74, 95%CI 1.29-2.33), pelvis/lower-extremity (aOR 1.57, 95%CI 1.23-2.00), spine (aOR 3.01, 95%CI 2.02-4.43); and 5-year increase in time period (aOR 0.80, 95%CI 0.70-0.91). CONCLUSIONS: We found decreasing trends in motorcycle crash and in-hospital mortality, increasing trends in rear passenger seats in cars over the 15-year period, and factors associated with in-hospital mortality such as type of mechanisms and concomitant injuries. Strengthening child road safety measures, particularly for rear passenger seats in vehicles, is imperative to enhance our dedication to injury prevention.

Impact of the COVID-19 pandemic on epidemiology, treatment, and outcome of major trauma in Japan in 2020: a retrospective observational nationwide registry-based study.

Aim: The nationwide impact of the coronavirus disease (COVID-19) pandemic on major trauma in Japan is unknown. The nationwide registry-based data of the Japanese Trauma Data Bank were analyzed to elucidate the impact of COVID-19 on the epidemiology, treatment, and outcomes of major trauma patients. Methods: Among patients transported directly from the injury site by ambulance with an Injury Severity Score of ≥16, we compared patients managed from April to December in 2019 to those managed from April to December in 2020. Results: In total, 9792 patients were included in this study (2019, n = 5194; 2020, n = 4598). There were no significant differences in age or sex, but there were significant differences between 2019 and 2020 in the rates of "self-injury (suicide)", "motor vehicle accident", "fall from height", "fall down", and "fall to the ground", which are factors associated with patient age. Injury severity in 2019 and 2020 did not differ to a statistically significant extent, but the rate of major spinal injury increased. The time of prehospital care significantly increased in 2020 compared to 2019. There was no noticeable change in hospital treatment or in-hospital mortality between 2019 and 2020. Conclusion: This study suggests that the COVID-19 pandemic might have altered the injuries of major trauma; however, medical services for major trauma were well supplied in Japan in 2020.

Energy expenditure and oxygen uptake kinetics in critically ill elderly patients.

BACKGROUND: Resting energy expenditure (REE) measurement of critically ill patients is essential for better nutrition management. Younger people increase their oxygen delivery ( ḊO2${\dot{{\rm{D}}}}{{\rm{O}}_2}$ ) to meet energy demands, but few reports have investigated oxygen uptake kinetics in elderly patients, which are the main target population in today's intensive care units (ICUs). In this study, we evaluated REE, ḊO2${\dot{{\rm{D}}}}{{\rm{O}}_2}$ , and oxygen extraction ratio (O2 Ext: oxygen consumption [ V̇O2${\dot{{\rm{V}}}}{{\rm{O}}_2}$ ]/ ḊO2${\dot{{\rm{D}}}}{{\rm{O}}_2}$ ) to clarify appropriate energy needs and consumption in elderly ICU patients. METHODS: This retrospective observational study included ventilated ICU patients who were divided into elderly participants (age ≥ 65 years) and nonelderly participants (age ≤64 years). V̇O2${\dot{{\rm{V}}}}{{\rm{O}}_2}$ , CO2 production, and cardiac output were measured by indirect calorimetry and noninvasive hemodynamic monitoring for up to 5 days. The initial values of REE, ḊO2${\dot{{\rm{D}}}}{{\rm{O}}_2}$ , and O2 Ext were compared between elderly and nonelderly patients. RESULTS: This study included 102 patients, of whom 52% (n = 53) were elderly. The absolute deviation of measured REE per ideal body weight (IBW) was significantly higher in elderly than in nonelderly patients (9.3 ± 6.9 vs 6.3 ± 6.6 kcal/kg; P < .01). ḊO2${\dot{{\rm{D}}}}{{\rm{O}}_2}$ had a strong negative correlation with age (P < .01). The O2 Ext value was significantly higher in elderly than in nonelderly patients (37 ± 19% vs 29 ± 13%; P = .03). CONCLUSIONS: Elderly critically ill patients were characterized by higher deviations in REE, lower ḊO2${\dot{{\rm{D}}}}{{\rm{O}}_2}$ , and higher O2 Ext. In elderly patients, O2 Ext rather than ḊO2${\dot{{\rm{D}}}}{{\rm{O}}_2}$ could be increased to meet energy consumption demands.

An Association of Influenza Epidemics in Children With Mobile App Data: Population-Based Observational Study in Osaka, Japan.

BACKGROUND: Early surveillance to prevent the spread of influenza is a major public health concern. If there is an association of influenza epidemics with mobile app data, it may be possible to forecast influenza earlier and more easily. OBJECTIVE: We aimed to assess the relationship between seasonal influenza and the frequency of mobile app use among children in Osaka Prefecture, Japan. METHODS: This was a retrospective observational study that was performed over a three-year period from January 2017 to December 2019. Using a linear regression model, we calculated the R2 value of the regression model to evaluate the relationship between the number of "fever" events selected in the mobile app and the number of influenza patients ≤14 years of age. We conducted three-fold cross-validation using data from two years as the training data set and the data of the remaining year as the test data set to evaluate the validity of the regression model. And we calculated Spearman correlation coefficients between the calculated number of influenza patients estimated using the regression model and the number of influenza patients, limited to the period from December to April when influenza is prevalent in Japan. RESULTS: We included 29,392 mobile app users. The R2 value for the linear regression model was 0.944, and the adjusted R2 value was 0.915. The mean Spearman correlation coefficient for the three regression models was 0.804. During the influenza season (December-April), the Spearman correlation coefficient between the number of influenza patients and the calculated number estimated using the linear regression model was 0.946 (P<.001). CONCLUSIONS: In this study, the number of times that mobile apps were used was positively associated with the number of influenza patients. In particular, there was a good association of the number of influenza patients with the number of "fever" events selected in the mobile app during the influenza epidemic season.

Assessing the impact of the national traffic safety campaign: a nationwide cohort study in Japan.

OBJECTIVES: This study aimed to examine the difference in mortality from serious road traffic injuries during the National Traffic Safety Campaign compared with other periods and identify the common mechanisms of injury by age group in Japan. DESIGN: A retrospective review of Japan Trauma Data Bank (JTDB). SETTING: A total of 280 participating major emergency institutions across Japan. PARTICIPANTS: Patients with road traffic injuries registered in JTDB between 2004 and 2018 were recruited in the study. We included patients injured by traffic crashes during the National Traffic Safety Campaigns and controls using a double control method. The National Traffic Safety Campaign comprises 10 consecutive days in spring and fall (20 days in each year), and controls was the same calendar days 2 weeks before and after the days in the National Traffic Safety Campaigns (40 days in each year) to control for weekday, seasonal and yearly trends. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was in-hospital mortality. The secondary outcome was the incidences of severe traffic injury. RESULTS: Among 126 857 patients recorded as road traffic injuries in JTDB, we identified 6181 patients (21 cases per day) with injuries occurring during the National Traffic Safety Campaigns and 12 382 controls (21 cases per day). The overall in-hospital mortality was 11.4%. We did not observe a significant difference in in-hospital mortality between the groups (11.8% vs 11.1%) with an adjusted OR of 1.05 (95% CI 0.95 to 1.16). The most common mechanism of injury in each age group was bicycle crash among children, motorcycle crash among adults and pedestrian among the elderly. CONCLUSIONS: We found no change in the incidence of severe traffic injury or in-hospital mortality during the National Traffic Safety Campaign in Japan. Serious road trauma was high for bicycles among children, motorcycles among adults and pedestrian among the elderly.

Incidence and Characteristics of Cranial Nerve Injuries: A Nationwide Observational Study in Japan.

Background: Large-scale data on cranial nerve injuries are scarce. Methods: This study enrolled 361,706 patients registered in the Japanese Trauma Data Bank from 2004 to 2018. We selected patients with cranial nerve injury using the corresponding Abbreviated Injury Scale codes and examined the incidence and characteristics. Results: In total, 347,101 patients were eligible for inclusion in our analysis. By mechanism of trauma, all cranial nerve injuries occurred in <1% of registered cases. The highest incidence was 0.2190% (55/25,117) for facial nerve injury in bicycle crash. By cause of trauma, all cranial nerve injuries occurred in <1% of registered cases. The highest incidence was 0.1943% (37/19,044) for facial nerve injury in occupational injury. No patients with spinal accessory nerve injury were observed. The most common cranial nerve injury was to the facial nerve (n = 278). Most cranial nerve injury patients are in the 30s to 50s age range, and there was a male predominance. Multiple cranial nerve injuries were observed in 81 patients. Many cranial nerve injury cases are complicated by skull base fractures. Conclusions: We revealed the incidence and characteristics of cranial nerve injury. Our findings may help physicians detect these injuries at an early stage in patients at risk.

Factors Associated with Traumatic Diaphragmatic Rupture among Patients with Chest or Abdominal Injury: A Nationwide Study from Japan.

BACKGROUND: Blunt traumatic diaphragmatic rupture (TDR) is a rare condition that is seen in patients with blunt thoracoabdominal trauma. However, factors that are associated with blunt TDR have not been fully revealed. The purpose of this study was to evaluate the factors that are associated with blunt TDR in trauma patients with a chest or abdominal injury using nationwide trauma registry data in Japan. METHOD: This study was a retrospective observational study with a 15-year study period from 2004 to 2018. We included trauma patients with a chest or abdominal Abbreviated Injury Score of two or more. We evaluated the relationship between confounding factors such as mechanism of injury and blunt TDR with multivariable logistic regression analysis. RESULTS: This study included 65,110 patients, of whom 496 patients (0.8%) suffered blunt TDR. Factors that were associated with blunt TDR were disturbance of consciousness (adjusted OR [AOR]: 1.639, 95% CI: 1.326-2.026), FAST positive (AOR: 2.120, 95% CI: 1.751-2.567), front seat passenger (AOR: 1.748, 95% CI: 1.129-2.706), and compression injury by heavy object (AOR: 1.677, 95% CI: 1.017-2.765). CONCLUSION: This study revealed several factors that are associated with blunt TDR. The results of this study may be useful for clinicians when estimating blunt TDR.

Factors Associated with Cardiac/Pericardial Injury among Blunt Injury Patients: A Nationwide Study in Japan.

The lack of established diagnostic criteria makes diagnosing blunt cardiac injury difficult. We investigated the factors associated with blunt cardiac injury using the Japan Trauma Data Bank (JTDB) in a multicenter observational study of blunt trauma patients conducted between 2004 and 2018. The primary outcome was the incidence of blunt cardiac/pericardial injury. Multivariable logistic regression analysis was used to identify factors independently associated with blunt cardiac injuries. Of the 228,513 patients, 1002 (0.4%) had blunt cardiac injury. Hypotension on hospital arrival (adjusted odds ratio (AOR) 4.536, 95% confidence interval (CI) 3.802-5.412), thoracic aortic injury (AOR 2.722, 95% CI 1.947-3.806), pulmonary contusion (AOR 2.532, 95% CI 2.204-2.909), rib fracture (AOR 1.362, 95% CI 1.147-1.618), sternal fracture (AOR 3.319, 95% CI 2.696-4.085). and hemothorax/pneumothorax (AOR 1.689, 95% CI 1.423-2.006)) was positively associated with blunt cardiac injury. Regarding the types of patients, car drivers had a higher rate of blunt cardiac injury compared to other types of patients. Driving a car, hypotension on hospital arrival, thoracic aortic injury, pulmonary contusion, rib fracture, sternal fracture, and hemothorax/pneumothorax were positively associated with blunt cardiac injury.

Relationship between in-hospital mortality and abdominal angiography among patients with blunt liver injuries: a propensity score-matching from a nationwide trauma registry of Japan.

AIM: To assess relationships between abdominal angiography and outcomes in adults with blunt liver injuries. METHODS: A retrospective observational study carried out from January 2004 to December 2018. Adult blunt-trauma patients with AAST grade Ⅲ-Ⅴ were analyzed with in-hospital mortality as the primary outcome using propensity-score-(PS) matching to seek associations with abdominal angiography findings. RESULTS: A total of 1,821 patients were included, of which 854 had available abdominal angiography data (AA+) and 967 did not (AA-). From these, 562 patients were selected from each group by propensity score matching. In-hospital mortality was found to be lower in the AA+ than in the AA- group (15.1% [87/562] versus 25.4% [143/562]; odds ratio 0.544, 95% confidence interval 0.398-0.739). CONCLUSION: Abdominal angiography is shown to be of benefit for adult patients with blunt liver injury in terms of their lower in-hospital mortality.

Gut Microbiota and Probiotics/Synbiotics for Modulation of Immunity in Critically Ill Patients.

Patients suffering from critical illness have host inflammatory responses against injuries, such as infection and trauma, that can lead to tissue damage, organ failure, and death. Modulation of host immune response as well as infection and damage control are detrimental factors in the management of systemic inflammation. The gut is the motor of multiple organ failure following injury, and it is recognized that gut dysfunction is one of the causative factors of disease progression. The gut microbiota has a role in maintaining host immunity, and disruption of the gut microbiota might induce an immunosuppressive condition in critically ill patients. Treatment with probiotics and synbiotics has been reported to attenuate systemic inflammation by maintaining gut microbiota and to reduce postoperative infectious complications and ventilator-associated pneumonia. The administration of prophylactic probiotics/synbiotics could be an important treatment option for preventing infectious complications and modulating immunity. Further basic and clinical research is needed to promote intestinal therapies for critically ill patients.

A Mobile App for Self-Triage for Pediatric Emergency Patients in Japan: 4 Year Descriptive Epidemiological Study.

BACKGROUND: When children suffer sudden illness or injury, many parents wonder whether they should go to the hospital immediately or call an ambulance. In 2015, we developed a mobile app that allows parents or guardians to determine the urgency of their child's condition or call an ambulance and that indicates available hospitals and clinics when their child is suddenly sick or injured by simple selection of the child's chief complaints and symptoms. However, the effectiveness of medical apps used by the general public has not been well evaluated. OBJECTIVE: The purpose of this study was to clarify the use profile of this mobile app based on data usage in the app. METHODS: This study was a descriptive epidemiological study with a 4-year study period running from January 2016 to December 2019. We included cases in which the app was used either by the children themselves or by their parents and other guardians. Cases in which the app was downloaded but never actually used were excluded from this study. Continuous variables are presented as median and IQR, and categorical variables are presented as actual number and percentages. RESULTS: The app was used during the study period for 59,375 children whose median age was 1 year (IQR 0-3 years). The app was used for 33,874 (57.05%) infants, 16,228 (27.33%) toddlers, 8102 (13.65%) elementary school students, and 1117 (1.88%) junior high school students, with 54 (0.09%) having an unknown status. Furthermore, 31,519 (53.08%) were male and 27,329 (46.03%) were female, with sex being unknown for 527 (0.89%) children. "Sickness" was chosen for 49,101 (78.51%) patients, and "injury, poisoning, foreign, substances and others" was chosen for 13,441 (21.49%). For "sickness," "fever" was the most commonly selected option (22,773, 36.41%), followed by "cough" (4054, 6.48%), and "nausea/vomiting" (3528, 5.64%), whereas for "injury, poisoning, foreign substances and others," "head and neck injury" was the most commonly selected option (3887, 6.22%), followed by "face and extremities injury" (1493, 2.39%) and "injury and foreign substances in eyes" (1255, 2.01%). CONCLUSIONS: This study clarified the profile of use of a self-triage app for pediatric emergency patients in Japan.