Variation in the utilization of angioembolization for splenic injury in hospitals: a nationwide cross-sectional study in Japan.

Aim: Substantial variations in the utilization of angioembolization have been reported internationally. However, the existence of variations in the utilization of angioembolization in Japan is currently unknown.

Methods: This was a cross-sectional study using data from a nationwide trauma registry in Japan.

Embolization versus Surgery for Stabilized Patients with Solid Organ Injury.

Purpose: To compare embolization with laparotomy for the management of hemodynamically unstable patients with solid organ injury who responded to initial resuscitation.

Materials And Methods: Data from a Japanese nationwide trauma registry were analyzed. Included were hemodynamically unstable patients (systolic blood pressure <90 mm Hg and blood transfusion within the first 24 hours) whose initial computed tomography assessment confirmed the presence of solid organ injuries (liver and/or spleen).

Delayed embolization associated with increased mortality in pelvic fracture with hemodynamic stability at hospital arrival.

Background: Embolization is widely used for controlling arterial hemorrhage associated with pelvic fracture. However, the effect of a delay in embolization among hemodynamically stable patients at hospital arrival with a pelvic fracture is unknown. Therefore, our aim was to investigate the association between the time to embolization and mortality in hemodynamically stable patients at hospital arrival with a pelvic fracture.

Severe liver trauma among pediatric patients in the Japan Trauma Registry.

Background: Limited information exists regarding the clinical characteristics, management practices, and outcomes of pediatric patients with liver injury in Japan. The aim of this study is to evaluate the characteristics, management, and outcome of pediatric patients with liver injury in Japan.

Methods: We conducted a multicenter, retrospective cohort study using data from the Japan Trauma Data Bank between 2004 and 2018.

Isolated high-grade splenic injury among pediatric patients in Japan: Nationwide descriptive study.

Background: Limited information exists regarding the clinical characteristics, management practice, and outcomes of pediatric patients with isolated splenic injury in Japan. This study aimed to evaluate the characteristics, management, and outcomes, such as survival and splenic salvage rate of pediatric patients with isolated splenic injury in Japan.

Method: This study was a multicenter retrospective cohort study using patient data from the Japan Trauma Data Bank (JTDB) collected between 2004 and 2018.

Resuscitative endovascular balloon occlusion of the aorta may contribute to improved survival.

Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an increasingly used trauma resuscitation procedure, however, there are no reports of whether or not the survival of patients treated with REBOA increases over time.

Methods: This retrospective cohort study from a nationwide trauma registry in Japan was conducted between 2004 and 2015. Patients treated with REBOA were divided into three calendar year periods: early-period (2004-2007), mid-period (2008-2011), and late-period (2012-2015).

The off-hour effect among severe trauma patients: a nationwide cohort study in Japan.

Purpose: To assess whether there are temporal differences altering the clinical outcomes of severe trauma patients in Japan.

Methods: This was a retrospective cohort study that used recorded data from the Japan Trauma Data Bank. Severe trauma patients who had an injury severity score of greater than 16 were included.

Severe trauma patient volume was associated with decreased mortality.

Background: The relationship between the severe trauma patient volume and outcomes is still being debated. The aim of this study was to evaluate the relationship between severe trauma patient volume, hospital mortality, and door-to-definitive treatment time.

Methods: This was a retrospective cohort study that used recorded data from the Japan Trauma Data Bank.

Levels of Catecholamines in the Plasma of Patients with Cardiopulmonary Arrest.

So far, there remains a controversy regarding the efficacy of epinephrine (Ep) in patients with cardiopulmonary arrest (CPA). In this study, we evaluated the importance of the plasma levels of catecholamines prior to the administration of Ep in patients with CPA. Patients with out-of-hospital cardiac arrest (OHCA) who were transferred to Gunma University Hospital were enrolled prospectively between July 2014 and July 2017.

Prediction of arterial extravasation in pelvic fracture patients with stable hemodynamics using coagulation biomarkers.

Background: Determining the presence of an active arterial hemorrhage in the acute phase is important as a treatment strategy in patients with pelvic fracture. The purpose of this study was to evaluate whether coagulation biomarkers could predict arterial extravasation, especially in pelvic fracture patients with stable hemodynamics.

Methods: We studied patients with a pelvic fracture who had a systolic blood pressure above 90 mmHg and lactate level less than 5.

Efficacy of the Treatment of Elderly Trauma Patients Requiring Intensive Care.

Purpose: To evaluate the effectiveness of intensive care for the elderly trauma patients aged 80 years and older.

Methods: Trauma patients admitted to the intensive care unit (ICU) through the emergency room (ER) at our hospital between January 2013 and December 2016 were analyzed. Patients were divided into two groups: patients aged 80 and older (group E) and <80 years old (group Y).

Use of Vasopressor Increases the Risk of Mortality in Traumatic Hemorrhagic Shock: A Nationwide Cohort Study in Japan.

Objectives: To evaluate the possible association of vasopressor use with mortality in traumatic hemorrhagic shock patients.

Design: Retrospective cohort study.

Setting: Traumatic hemorrhagic shock patients at 260 emergency hospitals in Japan between 2004 and 2015.

Report of Four Cases with Equestrian Injury: Therapeutic Approach and Outcome.

Equestrianism is associated with a risk of severe trauma due to falls and/or direct injury from the horse, depending on the mechanism of injury. This article presents four cases of equestrian injury treated in Gunma University Hospital: Case 1: hepatic injury (fall and kick by the horse); Case 2: left hemopneumothorax and pulmonary contusion with multiple rib fractures (fall and trampling by the horse); Case 3: lumbar compression fracture (fall); and Case 4: scrotum injury (horse bite). Equestrian injuries may be high-energy traumas.

Successful Endovascular Therapy in an Elderly Patient with Severe Hemorrhage Caused by Traumatic Injury.

An 85-year-old female suffered pelvic fracture, multiple rib fractures, right hemopneumothorax, and blunt abdominal aortic injury in a traffic accident. After transfer to our hospital, transcatheter arterial embolization (TAE) was performed immediately for hemorrhage from the bilateral internal iliac arteries. Enhanced computed tomography (CT) after TAE showed an increase of hematoma and extravasation at the bifurcation of the abdominal aorta.

Can the Wish to Receive Intensive Treatment in Elderly Patients with Respiratory Tract Infection Be Predicted?

Objective Almost no Japanese elderly patients have an advance directive (AD). Our aim was to determine whether or not the wish to receive intensive care in elderly patients with respiratory tract infection could be predicted from the prehospital data. Methods In this retrospective study, we reviewed patients ≥65 years of age with respiratory tract infection who had been transferred to our hospital by ambulance between September 2014 and August 2016.

Transcatheter Arterial Embolization of a Lumbar Artery Injury with Traumatic Aortic Dissection.

Whole-body-enhanced computed tomography of a septuagenarian woman hit by a truck revealed a traumatic aortic dissection (Stanford B) and arterial bleeding from the right lumbar artery in the right iliopsoas muscle. Angiography revealed an active arterial extravasation from a false lumen of the left lumbar artery. We performed a transcatheter arterial embolization (TAE) of the right lumbar artery.

The Significance of Strong Ion Gap for Predicting Return of Spontaneous Circulation in Patients with Cardiopulmonary Arrest.

Useful parameters that can predict return of spontaneous circulation (ROSC) in patients with cardiopulmonary arrest (CPA) have not been established. We previously reported the usefulness of anion gap (AG) and albumin-corrected anion gap (ACAG) calculated from a blood sample obtained on arrival at the hospital for the prediction of ROSC. Otherwise, it has been reported that strong ion gap (SIG), which shows the difference between the levels of fully dissociated cations and anions in the serum, is useful to predict the prognosis of critically ill patients.

FDP/fibrinogen ratio reflects the requirement of packed red blood cell transfusion in patients with blunt trauma.

Purpose: To find factors that predict the requirement of packed red blood cells (pRBC) transfusion in patients with blunt trauma on arrival at the hospital.

Methods: We conducted blood tests in trauma patients whose trauma severity was suspected as being 3 and over in the Abbreviated Injury Scale. Patients were divided into the blood transfusion (BT) and control groups according to the requirement of pRBC transfusion within 24h after arrival.

Does the number of emergency medical technicians affect the neurological outcome of patients with out-of-hospital cardiac arrest?

Background: It is unclear whether the number of paramedics in an ambulance improves the outcome of patients with out-of-hospital cardiac arrest (OHCA) or not.

Methods And Results: This study was a prospective, observational study conducted on patients with OHCA. Patients were divided into the One-paramedic group (Group O) and the Two-or-more-paramedic group (Group T) and we analyzed the differences.

Deep Vein Thrombus Occurring Immediately After Blunt Abdominal Trauma.

Case: A 13-year-old adolescent girl with blunt abdominal injury was transferred to our hospital. Enhanced computed tomography (CT) showed not only retroperitoneal hematoma around the inferior vena cava and left common iliac vein but also thrombus extending from the left common iliac vein to the femoral vein.

Outcome: Enhanced CT performed on the second day revealed no increase in retroperitoneal hematoma and a new small thrombus in the popliteal vein.

Prediction of extravasation in pelvic fracture using coagulation biomarkers.

Purpose: To evaluate the usefulness of coagulation biomarkers, which are easy and quick to analyze in emergency settings, for prediction of arterial extravasation due to pelvic fracture.

Patients And Methods: The medical records of pelvic fracture patients transferred to the emergency department of Gunma University Hospital between December 2009 and May 2015 were reviewed. Patients were divided into two groups, those with (Extra(+)) and without (Extra(-)) arterial extravasation on enhanced CT or angiography.

Post-traumatic hypopituitarism: report of a child case.

Case: We report a case of post-traumatic hypopituitarism in a 9-year-old boy who was injured in a car accident.

Outcome: Post-traumatic hypopituitarism might be caused by moderate to severe head trauma, and while this possibility has recently drawn attention in adults, few reports are available regarding children. Our patient experienced head and facial injury, resulting in post-traumatic hypopituitarism.

Study on the priority of coronary arteriography or therapeutic hypothermia after return of spontaneous circulation in patients with out-of-hospital cardiac arrest: results from the SOS-KANTO 2012 study.

Many emergency physicians struggle with the clinical question of whether to perform therapeutic hypothermia (TH) or coronary angiography (CAG) first after return of spontaneous circulation (ROSC) in patients with out-of-hospital cardiac arrest (OHCA). We analyzed the results of the SOS-KANTO 2012 study, which is a prospective, multicenter (67 emergency hospitals), observational study about OHCA conducted between January 2012 and March 2013 (n = 16,452). We compared two groups: the group in which TH was first performed (TH group), and the group in which CAG was performed first (CAG group) within 24 h after arrival.