[Purpose] We examined differences in injury sites and severity by traffic accident types, using data registered in the Japanese Trauma Data Bank (JTDB). [Subjects and methods] This study involved 13,258 cases with road traffic injuries that had been registered in the JTDB over the 5-year period from 2004 to 2008. Data for (1) age, (2) mechanism of injury, (3) diagnosis, and (4) injury severity were obtained. [Statistical analysis] Residual analysis was performed. [Results] In regard to the head, there were only a few severe or worse injuries among drivers and those in the passenger seats of vehicles and motorcyclists, whereas severe injuries were common among bicyclists and pedestrians. Facial injuries were numerous in bicyclists, many of which were moderate to severe. While chest and abdominal injuries were common among drivers and those in the passenger seats of vehicles, there were many severe chest injuries among motorcyclists. Spinal injuries were often sustained by passengers in vehicles. [Conclusion] This study revealed differences in injury sites according to traffic accident types. We hope that this study will contribute to devising measures for reducing both the number and the severity of traffic injuries.
In many facilities treating trauma patients, duplicate coding is performed for trauma diagnoses using two different classification systems : the International Classification of Diseases and Related Health Problems (ICD) for administrative purposes and the Abbreviated Injury Scale (AIS) for the trauma registry. As unambiguous conversion of codes between ICD and AIS is not always possible due to the different structures of the two systems, we have developed a new bridging classification system that can be used to unambiguously convert both ICD and AIS. Development of the new classification system used the following strategies to assure its compatibility with both ICD and AIS : suspension of the multiple-injury codes in ICD, adoption of the more detailed categorization when the granularity of categorizations differs between ICD and AIS, and adoption of all classification boundaries when the boundaries differ between ICD and AIS (as seen in anatomical categories of extremities). The new classification system has the potential to avoid the additional cost associated with duplicate coding, and to facilitate improved evaluation and quality of trauma care based on the trauma registry data.
Background : A regional trauma registry (TR) collects injury data from multiple hospitals in a given region. The differences among TRs might provide useful information for improving or developing a TR.
Aim : To describe differences among TRs and investigate the effect of inclusion criteria on patient demographics.
Methods : I included national, state and multinational trauma registries for this study. I searched TRs by using the MEDLINE and an internet search engine. I abstracted funding sources, AIS versions, data submission methods, inclusion criteria and demographics of each TR. I compared the number of case registrations, the proportion of cases with an ISS>15 and a crude mortality rate of TRs that included “an ISS>15” or “an admission to ICU” in inclusion criteria with those of TRs that did not.
Results : I identified 17 TRs. Governmental funding, the AIS 98 and web-based data submission were the most common. The uses of “an ISS>15” and “an admission to ICU” significantly increased the proportion of cases with an ISS>15 and a crude mortality rate, respectively.
Conclusion : I identified the differences among TRs and the effects of inclusion criteria on patient demographics. These findings might be useful when improving or developing TRs.
This case involved a 72-year-old male who had a high inhibitor titer of 376.1 BU/ml while being treated for hemophilia A at this hospital. The patient had been struck by a car while crossing the street and was transferred to the emergency department of this hospital. The patient had extensive crushing of soft tissue throughout the body along with ecchymoses and intramuscular hematomas. Open fracture of the shafts of the left tibia and fibula, dislocation of the left knee, and a fracture of the shaft of the right femur were noted, and the patient also had active bleeding. Bypass therapy was attempted to achieve hemostasis ; external fixation was used to treat the fracture and reduction and skeletal traction were used to treat the dislocation, but compartment syndrome was noted in the left leg on day 1 postoperatively. Control of bleeding was difficult. The patient developed DIC on day 6 postoperatively and pneumonia on day 8 and passed away on day 11.
Damage control surgery (DCS) is used extensively in severe hepatic injury patients who show signs of physiological deterioration. However, hepatectomy is used in a few cases to treat severe hepatic injury. Thus, consensus on the best possible surgical strategy for severe hepatic injury is yet to be reached. In this study, we evaluated the efficacy of perihepatic packing that is performed as a part of DCS for treating severe hepatic injury. Of 56 severe hepatic injury patients who had undergone DCS, 45 were assessed. Perihepatic packing was performed in all patients (n = 56), and the physiological state, deadly triad parameters, and prognosis were evaluated. All patients were in shock on arrival (shock index, 1.7±0.1), and the revised trauma scale (RTS) values and injury severity score (ISS) were 4.6 and 32.5, respectively. The prothrombin time, base excess, and body temperature were 43.6%, −16.0, and 34.8°, respectively. Twenty-two patients experienced cardiopulmonary arrest (CPA) on arrival or before perihepatic packing or died due to other fatal diseases. Of the remaining 23 patients, 18 (78.3%) survived after surgery. Further, among these 23 patients, 15 did not have injuries with an abbreviated injury scale (AIS) value of≥4 in body parts other than the abdomen ; of these 15 patients, 14 (93.3%) survived after surgery. It is suggested that perihepatic packing, which is capable of alleviating hemorrhage, is an excellent surgical option for treating severe hepatic injury.
Two treatments for traumatic optic neuropathy are conservative therapy, mainly with steroids, and optic canal decompression surgery. There has been a debate on which treatment is more effective in visual acuity convalescence. After examining ten traumatic optic neuropathy cases at our hospital, we came to the conclusion that in order to see improvement in visual acuity convalescence, the basal visual acuity at the time of admission should be good and treatment should be started as soon as possible. Therefore, if traumatic optic neuropathy is suspected based on the patient's clinical history, physical findings, and image views, we should confirm his or her pupil size and proceed with a speedy diagnosis.
A 48-year-old woman who had stabbed herself was transferred to our ER. Her vital signs were hemodynamically stable, and no signs of peritonitis were seen on physical examination. Extravasation of contrast material and retroperitoneal hematoma around the aortic bifurcation were revealed by a contrast enhanced CT, and thus we planned transcatheter arterial embolization and laparotomy. Angiography revealed that the 3rd and 4th lumbar arteries were responsible for the hemorrhage, and these were successfully embolized using metallic coils. On laparotomy, omentum injury and retroperitoneal hematoma were found, but these did not require surgical intervention.
There are few reported cases of the abdominal stab wounds patients treated with transcatheter arterial embolization. The efficacy of this method has not been established ; however, the present case suggests angiographic intervention could be a useful treatment method in some cases of abdominal stab wounds.