重症頭部外傷の治療は変わったか：頭部外傷データバンクの検討

抄録

In the last decade, we have experienced substantial changes of medicosocial systems, e.g. introductions of the treatment guideline, the diagnosis related groups ⁄ prospective payment system by diagnosis procedure combination (DPC), or the compulsory system for postgraduate clinical training, which may influence medical affairs and hospital managements. In the present study, changes in managements of severe head injury were evaluated using the data from Japan Neurotrauma Databank Project 1998 (1998–2001: n=1002) and Project 2004 (2004–2006: n=1101). The results indicated that the executing rates of brain hypothermia and intracranial pressure (ICP) monitoring decreased. The cases with evacuated acute subdural hematoma showed the largest reduction in executing rates of ICP monitoring. In Project 2004, induced normothermia has been introduced as a novel management for brain protection, replacing hypothermia. These findings suggest that management of severe head injury have been simplified and uniformed in the last decade.