特集：頭部外傷データバンク【プロジェクト2015】（原著）
交通外傷による重症頭部外傷症例の最近の動向：頭部外傷データバンクにみる疫学的特徴と転帰
キーワード:
Japan Neurotrauma Data Bank,
Severe head injury,
Traffic accident,
Clinical feature,
Outcomes
2019 年 42 巻 2 号 p. 109-118
詳細
2019 年 42 巻 2 号 p. 109-118
Recent traffic accident statistics have reported a decrease in the number of accidents. As the new project 2015 of the Japan Neurotrauma Data Bank (JNTDB) has been tabulated, the trend of severe head injury associated with recent traffic accidents was examined in comparison with previous projects.
The survey was conducted in the 24 months between 2015 and 2017. We examined severe head injury of Glasgow Coma Scale (GCS) score 8 or less at the age of 6 years or older at the time of injury. The number of target cases is 832 for p1998, 797 for p2004, 753 for p2009, and 924 for p2015. We examined the proportion of traffic trauma cases, the condition of the victim, the age, the drinking condition, the means of transportation, the transportation time, the neurological evaluation, the physiological evaluation, the first CT findings, and the outcome at discharge. Furthermore, some examinations are divided into age groups (A group: under 45 years, B group: 45 to 64 years, C group: 65 to 74 years, D group: 75 years or more) and comparison about age group changes was added.
The proportion of traffic injuries among registered cases decreased to 64.7% in p1998, 53.8% in p2004, and 43.2% in p2009, but turned to 44.7% in p2015. The number of traffic injuries per institution decreased to 17.9 for p1998, 11.3 for p2004, 7.4 for p2009, and 6.5 for p2015 for one year. By age group, it turned from p2009 in D group and from p2015 in C group, and while the aging progressed, the decreasing trend tended to converge. The injury situation was the lowest in the four–wheeled vehicle, the accident while riding on a motorcycle at p2015, and the accident while walking increased mainly to the elderly. The drinking situation was slightly reduced in p2015 compared to p2009. The driver’s seat belt use decreased slightly from p2009 to 37.0% in p2015. The helmet wear also decreased to 45.0% in p2015. The possibility of reduction of the case by improvement of the safety device is also considered. Transportation by helicopter and doctor car increased to 17.9% together, and there was an increase in the chances for medical workers to get in touch with the sick persons at an early stage. There was no significant difference between systolic blood pressure and PaO2 and GCS at the hospital arrival, and the ISS temporarily deteriorated at p2009 was alleviated at p2015. CT findings showed that diffuse injury characteristically decreased in group D. The outcome at discharge was not significantly changed in GR and MD, and the increase in SD and VS and the decrease in D were recognized as significant differences compared to p1998. By age group, good prognosis group (GR + MD) tends to improve outcome in group A. Mortality decreases in the C and D groups, and an increase in the poor prognosis group (SD + VS) is an issue for the future.
