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Citation
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Tachino J, Katayama Y, Kitamura T, Kiyohara K, Nakao S, Umemura Y, Ishida K, Hirose T, Nakagawa Y, Shimazu T. J. Trauma Acute Care Surg. 2020; ePub(ePub): ePub. |
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Abstract
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BACKGROUND: There have been no clinical studies to sufficiently reveal the interaction effect generated by combinations of injury regions of multiple trauma. We hypothesized that certain combinations of trauma regions might lead to increased risk of traumatic death and aimed to verify this hypothesis using a nationwide trauma registry in Japan.
MATERIALS AND METHODS: This was a retrospective study of trauma patients registered in the Japan Trauma Data Bank between 2004 and 2017. We included patients who suffered blunt trauma with an Injury Severity Score (ISS) of 16 or more. The trauma was classified into four regions (head, chest, abdomen, and extremities), and a multivariable logistic regression analysis was performed that included interaction terms derived from the combination of two regions as covariates.
RESULTS: We included 78,280 trauma patients in this study. Among them, 16,100 patients (20.6%) were discharged to death. Multivariable logistic regression showed the odds ratio (OR) of in-hospital death compared to patients without injury of an Abbreviated Injury Scale of 3 or more in each injured region as follows: head 2.31 (95% confidence interval [CI]: 2.13-2.51), chest 2.28 (95% CI: 2.17-2.39), abdomen 1.68 (95% CI: 1.56-1.82), and extremities 1.84 (95% CI: 1.76-1.93), respectively. In addition, the ORs of the statistically significant interaction terms were as follows: head·chest 1.29 (95% CI: 1.13-1.48), chest·abdomen 0.77 (95% CI: 0.67-0.88), chest·extremities 1.95 (95% CI: 1.77-2.14), and abdomen·extremities 0.70 (95% CI: 0.62-0.79), respectively.
CONCLUSION: In this population, among patients with multiple trauma, a combination of head·chest trauma and chest·extremities trauma was shown to increase the risk of traumatic death.
LEVEL OF EVIDENCE: Level IIIRetrospective.
Language: en |