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Open Access

Effects of a trauma center on early mortality after trauma in a regional city in Japan: a population-based study

Yuji Takahashi, Shuntaro Sato, Kazunori Yamashita, Naoya Matsumoto, Yoshihiro Nozaki, Tomohito Hirao, Goro Tajima, Takamitsu Inokuma, Shuhei Yamano, Kensuke Takahashi, Takashi Miyamoto, Kenichiro Inoue, Makoto Osaki, Osamu Tasaki
DOI: 10.1136/tsaco-2018-000291 Published 2 June 2019
Yuji Takahashi
1Department of Emergency Medicine, Unit of Clinical Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
2Inoue Hospital, Nagasaki, Japan
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Shuntaro Sato
3Clinical Research Center, Nagasaki University Hospital, Nagasaki, Japan
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Kazunori Yamashita
4Acute & Critical Care Center, Nagasaki University Hospital, Nagasaki, Japan
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Naoya Matsumoto
4Acute & Critical Care Center, Nagasaki University Hospital, Nagasaki, Japan
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Yoshihiro Nozaki
4Acute & Critical Care Center, Nagasaki University Hospital, Nagasaki, Japan
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Tomohito Hirao
4Acute & Critical Care Center, Nagasaki University Hospital, Nagasaki, Japan
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Goro Tajima
4Acute & Critical Care Center, Nagasaki University Hospital, Nagasaki, Japan
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Takamitsu Inokuma
4Acute & Critical Care Center, Nagasaki University Hospital, Nagasaki, Japan
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Shuhei Yamano
4Acute & Critical Care Center, Nagasaki University Hospital, Nagasaki, Japan
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Kensuke Takahashi
5Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
6Department of Infectious Diseases, Nagasaki University Hospital, Nagasaki, Japan
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Takashi Miyamoto
4Acute & Critical Care Center, Nagasaki University Hospital, Nagasaki, Japan
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Kenichiro Inoue
2Inoue Hospital, Nagasaki, Japan
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Makoto Osaki
7Department of Orthopaedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Osamu Tasaki
1Department of Emergency Medicine, Unit of Clinical Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
4Acute & Critical Care Center, Nagasaki University Hospital, Nagasaki, Japan
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Article Figures & Data

Figures

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  • Figure 1
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    Figure 1

    Derivation of the study sample from the standardized regional data in the Nagasaki medical region.

  • Figure 2
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    Figure 2

    Serial changes in morality. Black line represents overall mortality. *p<0.05 versus mortality of 2007–2011 by multivariable logistic regression model. NUH, transported to Nagasaki University Hospital; non-NUH, transported to non-Nagasaki University Hospital.

  • Figure 3
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    Figure 3

    ORs of death in each year as a reference with pre-EMC&TC period. A significant difference is recognized from fiscal year 2013. *p<0.05 versus mortality of 2007–2011 by multivariable logistic regression model.

Tables

  • Figures
  • Supplementary Materials
  • Table 1

    Outcome 1 week after injury

    Fiscal year
    2007200820092010201120122013201420152016
    Outcome
    Returned home230219232265229273314284307319
    Hospitalization1006105411271323131213851553162414561398
    Discharged137153177204153149131187213219
    Transferred to a higher level medical institution37253835535748365067
    Transferred to other institution48454149707494698378
    Death in the ER2218272519221115178
    Death after hospitalization12121611151812111212
    Number of death
    All34304336344023262920
    Traumatic intracranial hemorrhage1112121513119151010
    Cardiovascular and lung injury5144384364
    Abdominal organ injury0123231111
    Pelvic fracture1031002230
    Proximal femur fracture2031233001
    Other fracture0102010020
    Severe multiple trauma1411191013124474
    Spinal cord injury1400120100
    NUH168131211221315139
    Non-NUH18223024231810111611
    Age 0–14 years0001000000
    Age 15–64 years1916241516198101510
    Age>64 years15141920182115161410
    Mortality (%)
    All2.322.61.91.821.1*1.2*1.4*1*
    NUH17.4918.69.47.614.88.210.910.37.6
    Non-NUH1.31.51.91.31.310.5*0.5*0.8*0.6*
    Age 0–14 years0002.2000000
    Age 15–64 years3.93.34.72.83.13.61.5*1.932.1
    Age>64 years1.51.41.71.51.41.5110.9*0.6*
    • We did not analyze patients aged 0–14 years old because the number of deaths was 0 except for 2010.

    • *p<0.05 versus mortality for years 2007–2011 by multivariable logistic regression model.

    • NUH, transported to Nagasaki University Hospital; non-NUH, transported to non-Nagasaki Univeristy Hospital.

  • Table 2

    Results of logistic regression model

    VariablesOR (95% CI)P value
    All patients
    Year
    2007–2011Reference
    20120.953 (0.637 to 1.427)0.815
    20130.528 (0.326 to 0.854)0.009
    20140.512 (0.321 to 0.817)0.005
    20150.618 (0.394 to 0.967)0.035
    20160.502 (0.303 to 0.832)0.008
    Age1.006 (1.000 to 1.013)0.068
    Sex
    MaleReference
    Female0.951 (0.721 to 1.253)0.720
    Site
    Non-NUHReference
    NUH2.945 (2.195 to 3.950)<0.001
    Disease
    Proximal femur fractureReference
    Traumatic intracranial hemorrhage16.361 (9.347 to 28.640)<0.001
    Cardiovascular and lung injury44.628 (23.362 to 85.253)<0.001
    Abdominal organ injury30.200 (13.561 to 67.255)<0.001
    Pelvic fracture3.676 (1.706 to 7.919)0.001
    Other fracture0.144 (0.056 to 0.375)<0.001
    Severe multiple trauma180.940 (96.494 to 339.286)<0.001
    Spinal cord injury6.181 (2.593 to 14.732)<0.001
    Time from emergencycall toarriveat hospital0.997 (0.990 to 1.005)0.505
    *Subgroup analyses
    Age 15–64 years
    2007–2011Reference
    20120.963 (0.574 to 1.616)0.885
    20130.408 (0.195 to 0.855)0.018
    20140.539 (0.275 to 1.057)0.072
    20150.946 (0.533 to 1.677)0.849
    20160.643 (0.327 to 1.265)0.201
    Age >64 years
    2007–2011Reference
    20120.969 (0.555 to 1.691)0.911
    20130.600 (0.329 to 1.094)0.096
    20140.589 (0.326 to 1.066)0.080
    20150.528 (0.285 to 0.978)0.042
    20160.482 (0.241 to 0.963)0.039
    • Each OR refers to mortality.

    • *For those under 15 years old, we did not analyze because death number was 0 except for 2010.

    • NUH, transported to Nagasaki University Hospital; non-NUH, transported to non-Nagasaki University Hospital.

Supplementary Materials

  • Figures
  • Tables
  • Supplementary data

    [tsaco-2018-000291supp001.docx]

  • Supplementary data

    [tsaco-2018-000291supp002.tif]

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Effects of a trauma center on early mortality after trauma in a regional city in Japan: a population-based study
Yuji Takahashi, Shuntaro Sato, Kazunori Yamashita, Naoya Matsumoto, Yoshihiro Nozaki, Tomohito Hirao, Goro Tajima, Takamitsu Inokuma, Shuhei Yamano, Kensuke Takahashi, Takashi Miyamoto, Kenichiro Inoue, Makoto Osaki, Osamu Tasaki
Trauma Surg Acute Care Open Jun 2019, 4 (1) e000291; DOI: 10.1136/tsaco-2018-000291

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Effects of a trauma center on early mortality after trauma in a regional city in Japan: a population-based study
Yuji Takahashi, Shuntaro Sato, Kazunori Yamashita, Naoya Matsumoto, Yoshihiro Nozaki, Tomohito Hirao, Goro Tajima, Takamitsu Inokuma, Shuhei Yamano, Kensuke Takahashi, Takashi Miyamoto, Kenichiro Inoue, Makoto Osaki, Osamu Tasaki
Trauma Surg Acute Care Open Jun 2019, 4 (1) e000291; DOI: 10.1136/tsaco-2018-000291
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Effects of a trauma center on early mortality after trauma in a regional city in Japan: a population-based study
Yuji Takahashi, Shuntaro Sato, Kazunori Yamashita, Naoya Matsumoto, Yoshihiro Nozaki, Tomohito Hirao, Goro Tajima, Takamitsu Inokuma, Shuhei Yamano, Kensuke Takahashi, Takashi Miyamoto, Kenichiro Inoue, Makoto Osaki, Osamu Tasaki
Trauma Surgery & Acute Care Open Jun 2019, 4 (1) e000291; DOI: 10.1136/tsaco-2018-000291
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