Association between whole blood ratio and risk of mortality in massively transfused trauma patients: retrospective cohort study.

BACKGROUND: Although whole blood (WB) transfusion was reported to improve survival in trauma patients with hemorrhagic shock, little is known whether a higher proportion of WB is associated with an improved survival. This study aimed to evaluate the association between whole blood ratio (WBR) and the risk of mortality in trauma patients requiring massive blood transfusion. METHODS: We performed a retrospective cohort study from the ACS-TQIP between 2020 and 2021. Patients were aged ≥ 18 years and received WB within 4 h of hospital arrival as a part of massive blood transfusion. Study patients were categorized into four groups based on the quartiles of WBR. Primary outcome was 24-h mortality and secondary outcome was 30-day mortality. Multivariable logistic regression analysis, fitted with generalized estimating equations, was performed to adjust for confounding factors and accounted for within-hospital clustering. RESULTS: A total of 4087 patients were eligible for analysis. The median age was 37 years (interquartile range [IQR]: 27-53 years), and 85.0% of patients were male. The median number of WB transfusions was 2.3 units (IQR 2.0-4.0 units), and the total transfusion volume was 4940 ml (IQR 3350-8504). When compared to the lowest WBR quartile, the highest WBR quartile had lower adjusted 24-h mortality (adjusted odds ratio [AOR]: 0.61, 95% confidence interval [CI]: 0.46-0.81) and 30-day mortality (AOR 0.58; 95% CI 0.45-0.75). CONCLUSION: The probability of mortality consistently decreased with higher WBR in trauma patients requiring massive blood transfusion.

The impact of the COVID-19 pandemic on other infections differs by their route of transmission: A retrospective, observational study in Japan.

INTRODUCTION: The Coronavirus disease 2019 (COVID-19) pandemic and people's subsequent behavioral changes have decreased the cases of respiratory infection worldwide. However, research on infectious diseases with other transmission modes is insufficient. The aim was to assess the impact of the COVID-19 pandemic on non-respiratory infectious diseases: infectious enterocolitis, sexually transmitted diseases such as human immunodeficiency virus (HIV) infection and syphilis, and tick-borne diseases. METHODS: This retrospective, cohort study used comprehensive surveillance data from the National Institute of Infectious Diseases in Japan from January 1, 2018, to December 31, 2021. The number of cases of infectious diseases before the COVID-19 pandemic (2018-2019) was compared with that during the COVID-19 pandemic (2020-2021). Reduction rates were calculated as the number of disease cases during the COVID-19 pandemic in 2020 and 2021, respectively, divided by the mean number of disease cases in 2018 and 2019. RESULTS: The total numbers of cases of infectious enterocolitis, sexually transmitted diseases, and tick-borne diseases during the study period were 2,507,304 cases, 24,972 cases, and 3012 cases, respectively. The number of cases decreased for infectious enterocolitis and sexually transmitted diseases during the COVID-19 pandemic compared with before the COVID-19 pandemic, with an approximately 40-50% decrease in enterocolitis and 30-55% decreases in sexually transmitted diseases. However, cases of tick-borne diseases changed little, with a 0.2% increase in 2020 and a 6% increase in 2021. CONCLUSION: The COVID-19 pandemic had a different impact on the number of cases of infectious diseases depending on their mode of transmission.

Trauma complications and in-hospital mortality: failure-to-rescue.

BACKGROUND: Reducing medical errors and minimizing complications have become the focus of quality improvement in medicine. Failure-to-rescue (FTR) is defined as death after a surgical complication, which is an institution-level surgical safety and quality metric that is an important variable affecting mortality rates in hospitals. This study aims to examine whether complication and FTR are different across low- and high-mortality hospitals for trauma care. METHODS: This was a retrospective cohort study performed at trauma care hospitals registered at Japan Trauma Data Bank (JTDB) from 2004 to 2017. Trauma patients aged ≥ 15 years with injury severity score (ISS) of ≥ 3 and those who survived for > 48 h after hospital admission were included. The hospitals in JTDB were categorized into three groups by standardized mortality rate. We compared trauma complications, FTR, and in-hospital mortality by a standardized mortality rate (divided by the institute-level quartile). RESULTS: Among 184,214 patients that were enrolled, the rate of any complication was 12.7%. The overall mortality rate was 3.7%, and the mortality rate among trauma patients without complications was only 2.8% (non-precedented deaths). However, the mortality rate among trauma patients with any complications was 10.2% (FTR). Hospitals were categorized into high- (40 facilities with 44,773 patients), average- (72 facilities with 102,368 patients), and low- (39 facilities with 37,073 patients) mortality hospitals, using the hospital ranking of a standardized mortality rate. High-mortality hospitals showed lower ISS than low-mortality hospitals [10 (IQR, 9-18) vs. 11 (IQR, 9-20), P < 0.01]. Patients in high-mortality hospitals showed more complications (14.2% vs. 11.2%, P < 0.01), in-hospital mortality (5.1% vs. 2.5%, P < 0.01), FTR (13.6% vs. 7.4%, P < 0.01), and non-precedented deaths (3.6% vs. 1.9%, P < 0.01) than those in low-mortality hospitals. CONCLUSIONS: Unlike reports of elective surgery, complication rates and FTR are associated with in-hospital mortality rates at the center level in trauma care.

Characteristics and outcomes of frail patients with suspected infection in intensive care units: a descriptive analysis from a multicenter cohort study.

BACKGROUND: Frailty is associated with morbidity and mortality in patients admitted to intensive care units (ICUs). However, the characteristics of frail patients with suspected infection remain unclear. We aimed to investigate the characteristics and outcomes of frail patients with suspected infection in ICUs. METHODS: This is a secondary analysis of a multicenter cohort study, including 22 ICUs in Japan. Adult patients (aged ≥16 years) with newly suspected infection from December 2017 to May 2018 were included. We compared baseline patient characteristics and outcomes among three frailty groups based on the Clinical Frailty Scale (CFS) score: fit (score, 1-3), vulnerable (score, 4), and frail (score, 5-9). We conducted subgroup analysis of patients with sepsis defined as per Sepsis-3 criteria. We also produced Kaplan-Meier survival curves for 90-day survival. RESULTS: We enrolled 650 patients with suspected infection, including 599 (92.2%) patients with sepsis. Patients with a median CFS score of 3 (interquartile range [IQR] 3-5) were included: 337 (51.8%) were fit, 109 (16.8%) were vulnerable, and 204 (31.4%) were frail. The median patient age was 72 years (IQR 60-81). The Sequential Organ Failure Assessment scores for fit, vulnerable, and frail patients were 7 (IQR 4-10), 8 (IQR 5-11), and 7 (IQR 5-10), respectively (p = 0.59). The median body temperatures of fit, vulnerable, and frail patients were 37.5 °C (IQR 36.5 °C-38.5 °C), 37.5 °C (IQR 36.4 °C-38.6 °C), and 37.0 °C (IQR 36.3 °C-38.1 °C), respectively (p < 0.01). The median C-reactive protein levels of fit, vulnerable, and frail patients were 13.6 (IQR 4.6-24.5), 12.1 (IQR 3.9-24.9), 10.5 (IQR 3.0-21.0) mg/dL, respectively (p < 0.01). In-hospital mortality did not statistically differ among the patients according to frailty (p = 0.19). Kaplan-Meier survival curves showed little difference in the mortality rate during short-term follow-up. However, more vulnerable and frail patients died after 30-day than fit patients; this difference was not statistically significant (p = 0.25). Compared with the fit and vulnerable groups, the rate of home discharge was lower in the frail group. CONCLUSION: Frail and vulnerable patients with suspected infection tend to have poor disease outcomes. However, they did not show a statistically significant increase in the 90-day mortality risk.

Implementation of earlier antibiotic administration in patients with severe sepsis and septic shock in Japan: a descriptive analysis of a prospective observational study.

BACKGROUND: Time to antibiotic administration is a key element in sepsis care; however, it is difficult to implement sepsis care bundles. Additionally, sepsis is different from other emergent conditions including acute coronary syndrome, stroke, or trauma. We aimed to describe the association between time to antibiotic administration and outcomes in patients with severe sepsis and septic shock in Japan. METHODS: This prospective observational study enrolled 1184 adult patients diagnosed with severe sepsis based on the Sepsis-2 criteria and admitted to 59 intensive care units (ICUs) in Japan between January 1, 2016, and March 31, 2017, as the sepsis cohort of the Focused Outcomes Research in Emergency Care in Acute Respiratory Distress Syndrome, Sepsis and Trauma (FORECAST) study. We compared the characteristics and in-hospital mortality of patients administered with antibiotics at varying durations after sepsis recognition, i.e., 0-60, 61-120, 121-180, 181-240, 241-360, and 361-1440 min, and estimated the impact of antibiotic timing on risk-adjusted in-hospital mortality using the generalized estimating equation model (GEE) with an exchangeable, within-group correlation matrix, with "hospital" as the grouping variable. RESULTS: Data from 1124 patients in 54 hospitals were used for analyses. Of these, 30.5% and 73.9% received antibiotics within 1 h and 3 h, respectively. Overall, the median time to antibiotic administration was 102 min [interquartile range (IQR), 55-189]. Compared with patients diagnosed in the emergency department [90 min (IQR, 48-164 min)], time to antibiotic administration was shortest in patients diagnosed in ICUs [60 min (39-180 min)] and longest in patients transferred from wards [120 min (62-226)]. Overall crude mortality was 23.4%, where patients in the 0-60 min group had the highest mortality (28.0%) and a risk-adjusted mortality rate [28.7% (95% CI 23.3-34.1%)], whereas those in the 61-120 min group had the lowest mortality (20.2%) and risk-adjusted mortality rates [21.6% (95% CI 16.5-26.6%)]. Differences in mortality were noted only between the 0-60 min and 61-120 min groups. CONCLUSIONS: We could not find any association between earlier antibiotic administration and reduction in in-hospital mortality in patients with severe sepsis.

Posterior Reversible Encephalopathy Syndrome: A Rare Childhood Case with Unconsciousness.

BACKGROUND: Posterior reversible encephalopathy syndrome (PRES) is a condition characterized by seizures, altered consciousness, visual disturbances, and headache. Characteristic findings on neuroimaging include cerebral edema, typically involving the parieto-occipital white matter. PRES has been associated with hypertension, autoimmune disease, and Henoch-Schölein purpura (HSP), but few cases have been reported, and fewer cases of PRES have been reported in children. CASE REPORT: We report the case of a 4-year-old girl who presented with blindness and semi-consciousness. The patient had no significant medical history and no abnormalities on physical examination or laboratory testing, although she had slightly elevated blood pressure. After hospitalization, the patient showed some characteristic signs of HSP and cranial magnetic resonance imaging revealed PRES as the cause of semi-consciousness. In our discussion, we examine the clinical features of PRES and remarkable points for the clinical diagnosis and management of this rare but important disease. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Although reports of PRES in children are rare, PRES should be considered in the differential diagnosis of children presenting with disturbance of consciousness. Emergency physicians should consult with pediatric physicians to confirm diagnoses of PRES and determine an appropriate treatment plan, given its variable etiology. Measurements of blood pressure, which are often missing in pediatric cases, can help physicians to arrive at a correct diagnosis.

Association between the development of intensive care unit-acquired weakness and body composition at intensive care unit admission: A descriptive study.

PURPOSE: To evaluate differences in body composition at intensive care unit (ICU) admission between patients with and without ICU-acquired weakness (ICU-AW). MATERIALS AND METHODS: This single-center, retrospective cohort study was conducted at Tsukuba Memorial Hospital's mixed ICU in Japan. We included patients who could walk unassisted before admission, received rehabilitation post-admission, and survived for at least 48 h. Body composition was assessed using bioelectrical impedance analysis (BIA) at ICU admission. Patients were classified into ICU-AW and non-ICU-AW groups, and their characteristics, outcomes, and body compositions were compared. RESULTS: Of the 282 patients analyzed, 28 (9.9 %) developed ICU-AW. ICU-AW patients were older (79 [72-86] vs. 70 [61-77], P < 0.01) and had higher SOFA scores (8 [5-13][ vs. 3 [2-6], P < 0.01). BIA showed a higher extracellular water to total body water ratio (0.408 [0.391-0.414] vs. 0.388 [0.380-0.400], P < 0.01) and a lower phase angle (3.7 [3.3-4.9] vs. 4.9 [4.2-5.7], P < 0.01) in the ICU-AW group. Skeletal muscle mass was similar between groups (23.2 [18.9-26.0] vs. 24.8 [20.5-28.3], P = 0.07). CONCLUSIONS: ICU-AW patients had poorer cellular nutritional status but similar skeletal muscle mass at ICU admission compared to non-ICU-AW patients.

Rapid resurgence of syphilis in Japan after the COVID-19 pandemic: A descriptive study.

Some countries have reported a post-pandemic resurgence in syphilis prevalence, but trend data in the World Health Organization Western Pacific Region (WHO-WPRO), including Japan, are severely lacking. Thus, the present study compares the number of syphilis cases before and after the COVID-19 pandemic in some WHO-WPRO countries. In addition, temporal trends in the number of syphilis cases in Japan pre- and post-pandemic are described. Annual numbers of syphilis cases during the study periods from China, New Zealand, Australia and Japan were compared. Annual trends of the numbers of syphilis cases during the same study periods were examined in Japan. In 2020, the number of syphilis-positive cases decreased in all four countries. In 2021, though, China, Australia and Japan all showed an increase in the numbers of syphilis cases. However, the rate of increase in China (+2.8%) and Australia (+4.8%) was low compared to Japan (+36.0%). The number of syphilis cases in New Zealand in 2021 was 12.6% lower than in 2020. In 2022, the number of cases of syphilis in China was 7.4% lower than in 2021. The increase of syphilis-positive cases was approximately 6.3-fold higher in Japan compared to Australia (+66.2% vs. +10.5%) in 2022. In conclusion, post-pandemic resurgence of syphilis occurred in Australia and Japan, but not in China and New Zealand. The reason for the substantial increase in syphilis-positive cases in Japan remains unclear. Post-pandemic, prevention and control of sexually transmitted infections still require attention.

Educational Utility of Clinical Vignettes Generated in Japanese by ChatGPT-4: Mixed Methods Study.

BACKGROUND: Evaluating the accuracy and educational utility of artificial intelligence-generated medical cases, especially those produced by large language models such as ChatGPT-4 (developed by OpenAI), is crucial yet underexplored. OBJECTIVE: This study aimed to assess the educational utility of ChatGPT-4-generated clinical vignettes and their applicability in educational settings. METHODS: Using a convergent mixed methods design, a web-based survey was conducted from January 8 to 28, 2024, to evaluate 18 medical cases generated by ChatGPT-4 in Japanese. In the survey, 6 main question items were used to evaluate the quality of the generated clinical vignettes and their educational utility, which are information quality, information accuracy, educational usefulness, clinical match, terminology accuracy (TA), and diagnosis difficulty. Feedback was solicited from physicians specializing in general internal medicine or general medicine and experienced in medical education. Chi-square and Mann-Whitney U tests were performed to identify differences among cases, and linear regression was used to examine trends associated with physicians' experience. Thematic analysis of qualitative feedback was performed to identify areas for improvement and confirm the educational utility of the cases. RESULTS: Of the 73 invited participants, 71 (97%) responded. The respondents, primarily male (64/71, 90%), spanned a broad range of practice years (from 1976 to 2017) and represented diverse hospital sizes throughout Japan. The majority deemed the information quality (mean 0.77, 95% CI 0.75-0.79) and information accuracy (mean 0.68, 95% CI 0.65-0.71) to be satisfactory, with these responses being based on binary data. The average scores assigned were 3.55 (95% CI 3.49-3.60) for educational usefulness, 3.70 (95% CI 3.65-3.75) for clinical match, 3.49 (95% CI 3.44-3.55) for TA, and 2.34 (95% CI 2.28-2.40) for diagnosis difficulty, based on a 5-point Likert scale. Statistical analysis showed significant variability in content quality and relevance across the cases (P<.001 after Bonferroni correction). Participants suggested improvements in generating physical findings, using natural language, and enhancing medical TA. The thematic analysis highlighted the need for clearer documentation, clinical information consistency, content relevance, and patient-centered case presentations. CONCLUSIONS: ChatGPT-4-generated medical cases written in Japanese possess considerable potential as resources in medical education, with recognized adequacy in quality and accuracy. Nevertheless, there is a notable need for enhancements in the precision and realism of case details. This study emphasizes ChatGPT-4's value as an adjunctive educational tool in the medical field, requiring expert oversight for optimal application.

Association Between the Rewarming Duration and Neurological Outcomes after Extracorporeal Cardiopulmonary Resuscitation Followed by Targeted Temperature Management for Out-of-Hospital Cardiac Arrests: A Secondary Analysis of the SAVE-J II Study.

There are no studies examining the association between rewarming durations and neurological outcomes after extracorporeal cardiopulmonary resuscitation (ECPR) followed by targeted temperature management (TTM) for patients with out-of-hospital cardiac arrest (OHCA). This study aimed to examine the association between rewarming durations and neurological outcomes after ECPR with TTM for patients with OHCA. This was a secondary analysis of the Advanced Life Support Study Registry for Ventricular Fibrillation with Extracorporeal Circulation in Japan study, a retrospective, multicenter study. Patients with OHCA who underwent ECPR and completed a TTM of 34°C and <34°C were included. Favorable neurological outcomes (cerebral performance categories 1-2) and survival upon hospital discharge were the primary outcomes. In total, 407 patients were included, with favorable neurological outcomes upon hospital discharge in 106 patients. The numbers of patients with rewarming durations of <24 hours, 24 hours, and >24 hours were 178, 133, and 96, respectively. In the multivariable analysis, a rewarming duration of <24 hours was not significantly associated with favorable neurological outcomes [odds ratio (OR): 1.06, 95% confidence interval (CI): 0.60-1.87, p = 0.84] or survival (OR: 0.96, 95% CI: 0.58-1.57, p = 0.86) compared with that of 24 hours, and that of <24 hours was not significantly associated with favorable neurological outcomes (OR: 0.74, 95% CI: 0.40-1.71, p = 0.56) or survival (OR: 0.74, 95% CI: 0.42-1.28, p = 0.38) than that of >24 hours. A rewarming duration of <24 hours in TTM after ECPR for OHCA was not significantly associated with favorable neurological outcomes or survival than that of 24 hours or >24 hours.

Epidemiology and patterns of empiric antimicrobial therapy practice in patients with community-onset sepsis using data from a Japanese nationwide medical claims database-the Japan Sepsis Alliance (JaSA) study group.

Objectives: We aimed to describe empiric antimicrobial options for patients with community-onset sepsis using nationwide real-world data from Japan. Methods: This retrospective cohort study used nationwide Japanese data from a medical reimbursement system database. Patients aged ≥20 years with both presumed infections and acute organ dysfunction who were admitted to hospitals from the outpatient department or emergency department between 2010 and 2017 were enrolled. We described the initial choices of antimicrobials for patients with sepsis stratified by intensive care unit (ICU) or ward. Results: There were 1,195,741 patients with community-onset sepsis; of these, 1,068,719 and 127,022 patients were admitted to the wards and ICU, respectively. Third-generation cephalosporins and carbapenem were most commonly used for patients with community-onset sepsis. We found that 1.7% and 6.0% of patients initially used antimicrobials for methicillin-resistant Staphylococcus aureus coverage in the wards and ICU, respectively. Although half of the patients initially used antipseudomonal agents, only a few patients used a combination of antipseudomonal agents. Moreover, few patients initially used a combination of antimicrobials to treat methicillin-resistant Staphylococcus aureus and Pseudomonas sp. Conclusion: Third-generation cephalosporins and carbapenem were most frequently used for patients with sepsis. A combination therapy of antimicrobials for drug-resistant bacteria coverage was rarely provided to these patients.

Impact of defibrillation with automated external defibrillator by bystander before defibrillation by emergency medical system personnel on neurological outcome of out-of-hospital cardiac arrest with non-cardiac etiology.

Aim of the study: Although defibrillation using automated external defibrillator (AED) by bystander prior to emergency medical system (EMS) arrival was associated with favorable outcomes in out-of-hospital cardiac arrest (OHCA) of cardiac cause, whether it improves outcomes of OHCA due to non-cardiac cause is not clear. We aimed to investigate the impact of defibrillation with AED by bystander before defibrillation by EMS personnel on the outcomes of OHCA of presumed non-cardiac cause. Methods: This was a retrospective cohort study using the All-Japan Utstein registry (reference period: 2013 to 2017). We included adult patients with OHCA of presumed non-cardiac cause, who had initial shockable rhythm, and who received witnessed arrest bystander cardiopulmonary resuscitation (CPR). Exposure variable was defibrillation with AED by bystander in comparison with initial defibrillation by EMS. Logistic regression analyses were conducted to assess the association between bystander AED shock and favorable neurological outcome (Cerebral Performance Category scale 1 or 2) at one month. Results: Among the 1,053 patients included for analysis, 57 (5.4%) received bystander AED shock. There was no statistically significant difference in the rate of favorable neurological outcome at one month between groups [9 (15.8%) vs 109 (10.9%), p = 0.26]. Logistic regression analysis adjusted for characteristics, intervention, and time course of CPR showed no association between bystander AED shock and favorable neurological outcome [OR (95% CI): 1.63 (0.70-3.77), p = 0.25]. Conclusion: In this study, defibrillation with AED by bystander before defibrillation by EMS personnel was not associated with the favorable outcomes of OHCA of presumed non-cardiac cause.

Association between intra-abdominal injured organs and abdominal compartment syndrome in patients with severe blunt trauma: A propensity score matched study using nationwide trauma registry in Japan.

INTRODUCTION: Abdominal compartment syndrome (ACS) after blunt abdominal trauma is a rare complication that requires early recognition and subsequent surgical intervention for optimal outcome. We aimed to investigate how differences in injured abdominal organs affect ACS development in patients with severe blunt abdominal trauma. METHODS: This nested case-control study used a nationwide registry of trauma patients, namely, the Japan Trauma Data Bank (JTDB), and only included patients aged ≥ 18 years with blunt severe abdominal trauma, defined as an AIS score of abdomen ≥ 3, sustained between 2004 and 2017. Patients without ACS were used as control subjects and identified using propensity score (PS) matching. Characteristics and outcomes between patients with and without ACS were compared and logistic regression was used to identify specific risk factors for ACS. RESULTS: Among 294,274 patients in the JTDB, 11,220 were eligible for inclusion before PS matching, and 150 (1.3%) developed ACS after trauma. PS matching led to the inclusion of 131 and 655 patients with and without ACS, respectively. Compared to controls, patients with ACS had higher number of injured organs in the abdomen and displayed a greater frequency of vascular and pancreatic injuries, need for blood transfusion, and disseminated intravascular coagulopathy, a complication of ACS. In-hospital mortality was higher in patients with ACS than those without ACS (51.1% vs. 26.0%, p < 0.01). Logistic regression analysis revealed that a higher number of injured organs in the abdomen [odds ratio (OR) (95% confidence interval [CI]): 1.76 (1.23-2.53)] and pancreatic injury [OR (95% CI): 1.53 (1.03-2.27)] were independently associated with ACS. CONCLUSIONS: Greater number of injured organs in abdomen and pancreatic injury are independent risk factors for the development of ACS.

The COVID-19 pandemic increased the demand for pneumococcal vaccination in Japan.

Although routine vaccinations in children decreased during the coronavirus disease 2019 (COVID-19) pandemic, pneumococcal vaccine coverage in older adults has remained unknown. This study was performed to investigate the impact of the COVID-19 pandemic on pneumococcal vaccination in Japan. The numbers of 23-valent pneumococcal polysaccharide vaccines (PPV23) shipped was obtained from an office memorandum released by the Ministry of Health, Labor and Welfare. The results showed that the COVID-19 pandemic increased the need for pneumococcal vaccination, causing shipping restrictions of pneumococcal vaccines. Regular vaccination is still important because there may be a shortage of vaccines during a pandemic.

Assessment of blood consumption score for pediatrics predicts transfusion requirements for children with trauma.

ABSTRACT: Although transfusion is a primary life-saving technique, the assessment of transfusion requirements in children with trauma at an early stage is challenging. We aimed to develop a scoring system for predicting transfusion requirements in children with trauma.This was a case-control study that employed a nationwide registry of patients with trauma (Japan Trauma Data Bank) and included patients aged <16 years with blunt trauma between 2004 and 2015. An assessment of blood consumption score for pediatrics (ped-ABC score) was developed based on previous literatures and clinical relevance. One point was assigned for each of the following criteria: systolic blood pressure ≤90 mm Hg, heart rate ≥120/min, Glasgow coma scale (GCS) score <15, and positive focused assessment with sonography for trauma (FAST) scan. For sensitivity analysis, we assessed age-adjusted ped-ABC scores using cutoff points for different ages.Among 5943 pediatric patients with trauma, 540 patients had transfusion within 24 hours after trauma. The in-hospital mortality rate was 2.6% (145/5615). The transfusion rate increased from 7.6% (430/5631) to 35.3% (110/312) in patients with systolic blood pressure ≤90 mm Hg (1 point), from 6.1% (276/4504) to 18.3% (264/1439) in patients with heart rate ≥120/min (1 point), from 4.1% (130/3198) to 14.9% (410/2745) in patients with disturbance of consciousness with GCS score <15 (1 point), and from 7.4% (400/5380) to 24.9% (140/563) in patients with positive FAST scan (1 point). Ped-ABC scores of 0, 1, 2, 3, and 4 points were associated with transfusion rates of 2.2% (48/2210), 7.5% (198/2628), 19.8% (181/912), 53.3% (88/165), and 89.3% (25/28), respectively. After age adjustment, c-statistic was 0.76 (95% confidence interval, 0.74-0.78).The ped-ABC score using vital signs and FAST scan may be helpful in predicting the requirement for transfusion within 24 hours in children with trauma.

Surgical mask use by healthcare personnel to prevent COVID-19 spread in a long-term care facility.

Long-term care facilities are a recognized high-risk setting for severe outcomes during the coronavirus disease 2019 (COVID-19) outbreak. This study describes a COVID-19 outbreak in a long-term care facility in Japan. The index case was a nurse who wore a surgical mask and used standard precautions. Of the 17 confirmed cases of COVID-19, 14 (14/93, 15.1%) were residents and three (3/69, 4.3%) were healthcare personnel (HCP); no visitors tested positive 0 (0/22, 0.0%). Mask utilization by HCP was not much effective in preventing COVID-19 transmission, even when interaction was not considered as being in close contact.

The impact of infection complications after trauma differs according to trauma severity.

The impact of infection on the prognosis of trauma patients according to severity remains unclear. We assessed the impact of infection complications on in-hospital mortality among patients with trauma according to severity. This retrospective cohort study used a nationwide registry of trauma patients. Patients aged ≥ 18 years with blunt or penetrating trauma who were admitted to intensive care units or general wards between 2004 and 2017 were included. We compared the baseline characteristics and outcomes between patients with and without infection and conducted a multivariable logistic regression analysis to investigate the impact of infection on in-hospital mortality according to trauma severity, which was classified as mild [Injury Severity Score (ISS) < 15], moderate (ISS 15-29), or severe (ISS ≥ 30). Among the 150,948 patients in this study, 10,338 (6.8%) developed infections. Patients with infection had greater in-hospital mortality than patients without infection [1085 (10.5%) vs. 2898 (2.1%), p < 0.01]. After adjusting for clinical characteristics, in-hospital mortality differed between trauma patients with and without infection according to trauma severity [17.1% (95% CI 15.2-18.9%) vs. 2.9% (95% CI 2.7-3.1%), p < 0.01, in patients with mild trauma; 14.8% (95% CI 13.3-16.3%) vs. 8.4% (95% CI 7.9-8.8%), p < 0.01, in patients with moderate trauma; and 13.5% (95% CI 11.2-15.7%) vs. 13.7% (95% CI 12.4-14.9%), p = 0.86, in patients with severe trauma]. In conclusion, the effect of infection complications in patients with trauma on in-hospital mortality differs by trauma severity.

A nested case-control study of risk for pulmonary embolism in the general trauma population using nationwide trauma registry data in Japan.

Post-trauma patients are at great risk of pulmonary embolism (PE), however, data assessing specific risk factors for post-traumatic PE are scarce. This was a nested case-control study using the Japan Trauma Data Bank between 2004 and 2017. We enrolled patients aged ≥ 16 years, Injury Severity Score ≥ 9, and length of hospital stay ≥ 2 days, with PE and without PE, using propensity score matching. We conducted logistic regression analyses to examine risk factors for PE. We included 719 patients with PE and 3595 patients without PE. Of these patients, 1864 [43.2%] were male, and their median Interquartile Range (IQR) age was 73 [55-84] years. The major mechanism of injury was blunt (4282 [99.3%]). Median [IQR] Injury Severity Score (ISS) was 10 [9-18]. In the multivariate analysis, the variables spinal injury [odds ratio (OR), 1.40 (1.03-1.89)]; long bone open fracture in upper extremity and lower extremity [OR, 1.51 (1.06-2.15) and OR, 3.69 (2.89-4.71), respectively]; central vein catheter [OR, 2.17 (1.44-3.27)]; and any surgery [OR, 4.48 (3.46-5.81)] were independently associated with PE. Spinal injury, long bone open fracture in extremities, central vein catheter placement, and any surgery were risk factors for post-traumatic PE. Prompt initiation of prophylaxis is needed for patients with such trauma.

Risk Factors of Fat Embolism Syndrome After Trauma: A Nested Case-Control Study With the Use of a Nationwide Trauma Registry in Japan.

BACKGROUND: Fat embolism syndrome (FES) is a rare syndrome resulting from a fat embolism, which is defined by the presence of fat globules in the pulmonary microcirculation; it is associated with a wide range of symptoms. RESEARCH QUESTION: What are the specific unknown risk factors for FES after we have controlled for basic characteristics and patient's severity? STUDY DESIGN AND METHODS: This was a nested case-control study that used the Japan Trauma Data Bank database from 2004 and 2017. We included patients with FES and identified patients without FES as control subjects using a propensity score matching. The primary outcome was the presence of FES during a hospital stay. RESULTS: There were 209 (0.1%) patients with FES after trauma; they were compared with 2,090 matched patients from 168,835 candidates for this study. Patients with FES had long bone and open fractures in their extremities more frequently than those without FES. Regarding treatments, patients with FES received bone reduction and fixation more than those without FES. Among patients who received bone reduction and fixation, time to operation was not different between the groups (P = .63). The overall in-hospital mortality rate was 5.8% in patients with FES and 3.4% in those without FES (P = .11). Conditional logistic regression models to identify risk factors associated with FES shows long bone and open fractures in extremities injury were associated with FES. Primary bone reduction and fixation was not associated independently with FES (OR, 1.80; 95% CI, 0.92-3.54), but delay time to the operation was associated with FES (OR, 2.21; 95% CI, 1.16-4.23). INTERPRETATION: Long bone and open fractures in injuries to the extremities were associated with FES. Although bone reduction and fixation were not associated with FES, delay time to the operation was associated with FES.