1
|
Yamada H, Aoki S, Nezu T, Neshige S, Motoda A, Yamazaki Y, Maruyama H. Emergency medical service response for cases of stroke-suspected seizure: A population-based study. J Stroke Cerebrovasc Dis 2024; 33:107681. [PMID: 38493957 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 03/02/2024] [Accepted: 03/14/2024] [Indexed: 03/19/2024] Open
Abstract
OBJECTIVES We evaluated the on-scene time of emergency medical services (EMS) for cases where discrimination between acute stroke and epileptic seizures at the initial examination was difficult and identified factors linked to delays in such scenarios. MATERIALS AND METHODS A retrospective review of cases with suspected seizure using the EMS database of fire departments across six Japanese cities between 2016 and 2021 was conducted. Patient classification was based on transport codes. We defined cases with stroke-suspected seizure as those in whom epileptic seizure was difficult to differentiate from stroke and evaluated their EMS on-scene time compared to those with epileptic seizures. RESULTS Among 30,439 cases with any seizures, 292 cases of stroke-suspected seizure and 8,737 cases of epileptic seizure were included. EMS on-scene time in cases of stroke-suspected seizure was shorter than in those with epileptic seizure after propensity score matching (15.1±7.2 min vs. 17.0±9.0 min; p = 0.007). Factors associated with delays included transport during nighttime (odds ratio [OR], 1.73, 95 % confidence interval [CI] 1.02-2.93, p = 0.041) and transport during the 2020-2021 pandemic (OR, 1.77, 95 % CI 1.08-2.90, p = 0.022). CONCLUSION This study highlighted the difference between the characteristics in EMS for stroke and epileptic seizure by evaluating the response to cases with stroke-suspected seizure. Facilitating prompt and smooth transfers of such cases to an appropriate medical facility after admission could optimize the operation of specialized medical resources.
Collapse
Affiliation(s)
- Hidetada Yamada
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima 734-8551, Japan
| | - Shiro Aoki
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima 734-8551, Japan.
| | - Tomohisa Nezu
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima 734-8551, Japan
| | - Shuichiro Neshige
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima 734-8551, Japan
| | - Atsuko Motoda
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima 734-8551, Japan
| | - Yu Yamazaki
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima 734-8551, Japan
| | - Hirofumi Maruyama
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima 734-8551, Japan
| |
Collapse
|
2
|
Arzoumanian A, Agopian A, Hovhannisyan M, Chekijian S, Baghdassarian A. Emergency medical services in Armenia: national call trends and future directions. Int J Emerg Med 2024; 17:65. [PMID: 38755551 PMCID: PMC11097514 DOI: 10.1186/s12245-024-00644-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 05/04/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Emergency medical services (EMS) are paramount to boosting health indices in lower-middle income countries (LMICs); however, lack of uniform data collection and analysis hinders system improvement efforts. In the present study, we describe patterns of EMS utilization in the Republic of Armenia and provide key insight into the quality of digital data collection methods. RESULTS For calls logged in the capital city, Yerevan, the majority had at least one missing field. The predominant complaint was high blood pressure among adults (34.4%) and fever among pediatrics (65.9%). A majority of patients were female (57.6%), adults (90.2%), and not transported to a hospital (85.0%). In the rural provinces, the data was largely intact. The predominant complaints were unspecified acute condition (27.4%) and high blood pressure (26.2%) among adults, and fever (43.9%) and unspecified acute condition (22.1%) among pediatrics. A majority of patients were female (57.1%), adults (94.2%), and not transported to a hospital (78.9%). CONCLUSIONS Our study reveals that the majority of calls to the EMS system are for concerns not needing in-hospital treatment and for acute exacerbation of chronic conditions. Our study also provides a critical foundation for the improvement of EMS systems in Armenia and in other nations in transition. The Locator software has the potential to be a valuable tool to the MoH if it is improved for surveillance purposes, and future synchronization of digital systems would provide easy access to critical information on population health needs and the effectiveness of public health interventions.
Collapse
Affiliation(s)
- Ani Arzoumanian
- Department of Psychological and Brain Sciences, Colgate University, Hamilton, USA.
| | - Anya Agopian
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Armenia
| | - Marine Hovhannisyan
- Department of Hygiene and Ecology, Yerevan State Medical University, Yerevan, Armenia
| | - Sharon Chekijian
- Department of Emergency Medicine, Yale School of Medicine, New Haven, USA
| | - Aline Baghdassarian
- Department of Pediatrics, Inova L.J. Murphy Children's Hospital, Falls Church, USA
| |
Collapse
|
3
|
Yamada H, Neshige S, Nonaka M, Takebayashi Y, Ishibashi H, Motoda A, Aoki S, Yamazaki Y, Maruyama H. On-scene time delays for epileptic seizures in developed community-based integrated care system regions. Epilepsy Behav 2024; 151:109612. [PMID: 38157824 DOI: 10.1016/j.yebeh.2023.109612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/22/2023] [Accepted: 12/23/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Delayed on-scene time by emergency medical services (EMS) can have detrimental effects on critical cases for people with epilepsy (PWE). In preparation for a super-aged society, a Community-based Integrated Care System is crucial to manage healthcare costs. However, sufficient coordination irrespective of sociomedical changes among medical providers is challenging. AIM This study aimed to evaluate on-scene time delays in the treatment of PWE, identify factors associated with such delays, and clarify regional differences. The focus was on the volume of acute care beds in regions with a developed Community-based Integrated Care System. METHODS This population-based observational study evaluated on-scene time delays in the treatment of PWE across six major cities in western Japan between 2017 and 2021. In addition, we also evaluated the association between regional differences focusing on volume of acute care beds ("Reduced region" and "Preserved region", as cities with numbers of acute care beds per 1,000 people below and above the national average, respectively) along with sociomedical factors associated with on-scene time delays. RESULTS This study included 8,737 PWE transported by EMS, with a mean on-scene time for EMS ranging from 12.9 ± 6.8 min to 21.7 ± 10.6 min. On-scene time delays were evident in Reduced regions, with an increase of 1.45 min (95 % confidence interval 0.86-2.03 min, p < 0.001). A high total EMS call volume independently influenced on-scene time delays during the middle period of the pandemic in Reduced regions. CONCLUSION Optimal coordination must be facilitated to ensure the effective functioning of the Community-based Integrated Care System, particularly during unusual circumstances.
Collapse
Affiliation(s)
- Hidetada Yamada
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima 734-8551, Japan
| | - Shuichiro Neshige
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima 734-8551, Japan.
| | - Megumi Nonaka
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima 734-8551, Japan
| | - Yoshiko Takebayashi
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima 734-8551, Japan
| | - Haruka Ishibashi
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima 734-8551, Japan
| | - Atsuko Motoda
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima 734-8551, Japan
| | - Shiro Aoki
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima 734-8551, Japan
| | - Yu Yamazaki
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima 734-8551, Japan
| | - Hirofumi Maruyama
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima 734-8551, Japan
| |
Collapse
|
4
|
Nakao S, Katayama Y, Kitamura T, Tanaka K, Hirose T, Tachino J, Iwami T, Masui J, Domi H, Shimazu T, Oda J, Matsuoka T. Assessing the impact of COVID-19 pandemic on ambulance transports for self-harm: a population-based study in Osaka Prefecture, Japan. BMJ Open 2023; 13:e074903. [PMID: 37699632 PMCID: PMC10503339 DOI: 10.1136/bmjopen-2023-074903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 08/31/2023] [Indexed: 09/14/2023] Open
Abstract
OBJECTIVES The COVID-19 pandemic might have affected emergency medical services transports for self-harm in Japan. However, the available data are insufficient to fully understand the pandemic's impact on ambulance transports due to self-harm. This study aimed to investigate the change in the incidence of ambulance transports for self-harm from 2018 to 2021 and to identify vulnerable age groups during the pandemic. DESIGN A population-based observational study using a database from the Osaka Prefectural Government. SETTING The database covers the entire area of Osaka Prefecture and included information on ambulance transports and hospital details. PARTICIPANTS Ambulance transport of patients due to self-harm from 2018 through 2021 was investigated. PRIMARY OUTCOME MEASURES The primary outcome was the incidence of ambulance transport for self-harm. RESULTS We analysed 10 843 patients. Their median age was 38 years, and 69.0% were female. We observed an increasing trend of the incidence rate in cases per 100 000 population per year from 29.4 in 2018 to 31.2 in 2021. However, after adjusting for age group, sex and month, there was no difference in the incidence of ambulance transport due to self-harm in 2019 (adjusted incidence rate ratio (aIRR) 1.007; 95% CI 0.955 to 1.063), 2020 (aIRR 1.041; 95% CI 0.987 to 1.098) and 2021 (aIRR 1.022; 95% CI 0.968 to 1.078), compared with 2018. We observed no difference in 21-day mortality from 2018 through 2021. In the age group of 20-29 years, despite no difference in 2019 compared with 2018, we found an 11.7% increase in the incidence of ambulance transport due to self-harm in 2020 (aIRR 1.117; 95% CI 1.002 to 1.245) and no difference in 2021. CONCLUSIONS There was no difference in the incidence of ambulance transport due to self-harm and 21-day mortality from 2018 through 2021. However, the incidence rate of ambulance transport due to self-harm in 2020 increased in the age group of 20-29 years.
Collapse
Affiliation(s)
- Shunichiro Nakao
- Department of Traumatology and Acute Critical Medicine, Osaka University Faculty of Medicine Graduate School of Medicine, Suita, Osaka, Japan
- The Working Group to Analyze the Emergency Medical Care System in Osaka Prefecture, Osaka, Japan
| | - Yusuke Katayama
- Department of Traumatology and Acute Critical Medicine, Osaka University Faculty of Medicine Graduate School of Medicine, Suita, Osaka, Japan
- The Working Group to Analyze the Emergency Medical Care System in Osaka Prefecture, Osaka, Japan
| | - Tetsuhisa Kitamura
- The Working Group to Analyze the Emergency Medical Care System in Osaka Prefecture, Osaka, Japan
- Department of Social and Environmental Medicine, Osaka University Faculty of Medicine Graduate School of Medicine, Suita, Osaka, Japan
| | - Kenta Tanaka
- The Working Group to Analyze the Emergency Medical Care System in Osaka Prefecture, Osaka, Japan
- Department of Social and Environmental Medicine, Osaka University Faculty of Medicine Graduate School of Medicine, Suita, Osaka, Japan
| | - Tomoya Hirose
- Department of Traumatology and Acute Critical Medicine, Osaka University Faculty of Medicine Graduate School of Medicine, Suita, Osaka, Japan
- The Working Group to Analyze the Emergency Medical Care System in Osaka Prefecture, Osaka, Japan
| | - Jotaro Tachino
- Department of Traumatology and Acute Critical Medicine, Osaka University Faculty of Medicine Graduate School of Medicine, Suita, Osaka, Japan
- The Working Group to Analyze the Emergency Medical Care System in Osaka Prefecture, Osaka, Japan
| | - Taku Iwami
- The Working Group to Analyze the Emergency Medical Care System in Osaka Prefecture, Osaka, Japan
- Health Service, Kyoto University, Kyoto, Japan
| | - Jun Masui
- The Working Group to Analyze the Emergency Medical Care System in Osaka Prefecture, Osaka, Japan
- Department of Emergency Medicine, Tane General Hospital, Osaka, Japan
| | - Hisaya Domi
- The Working Group to Analyze the Emergency Medical Care System in Osaka Prefecture, Osaka, Japan
| | | | - Jun Oda
- Department of Traumatology and Acute Critical Medicine, Osaka University Faculty of Medicine Graduate School of Medicine, Suita, Osaka, Japan
| | - Tetsuya Matsuoka
- The Working Group to Analyze the Emergency Medical Care System in Osaka Prefecture, Osaka, Japan
- Rinku General Medical Center, Izumisano, Osaka, Japan
| |
Collapse
|
5
|
Sato N, Takaku R, Chiba T, Higashi H, Shiga T. Impact of increased reimbursement for ambulance transportation on hospital acceptance in Japan: a difference-in-difference study. BMJ Open 2023; 13:e071523. [PMID: 37491094 PMCID: PMC10373704 DOI: 10.1136/bmjopen-2022-071523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
Abstract
OBJECTIVE Emergency medical services (EMS) often face difficulties in finding accepting hospitals in Japan. The universal medical insurance system in Japan increased the reimbursement for ambulance transportation acceptance at night, and on Sundays and holidays from 1 April 2016. This study investigated the effect of the reimbursement increase on the number of EMS calls, and transportation time from arrival at the scene to arrival at the hospital. DESIGN A difference-in-difference study. The treatment group consisted of people who called an ambulance at night while the control group consisted of people who called an ambulance during the daytime. SETTING The national ambulance records of the Fire and Disaster Management Agency in Japan from 1 April 2015 to 31 December 2016. PARTICIPANTS 7 625 463 ambulance dispatches were eligible for inclusion. PRIMARY AND SECONDARY OUTCOME MEASURES The changes in EMS calls, transportation time and the number of ambulance transports per 1000 population in one month in a comparison of daytime and night-time transport. RESULTS The treatment effect (night-time vs daytime) on the number of EMS calls was -0.013 (95% CI, -0.023 to -0.004), which was significant. The transportation time decreased slightly by 0.080 min (95% CI, -0.157 to -0.004). No impact was observed on the number of ambulance transports per 1000 population per month (0.00; 95% CI, -0.008 to 0.002). CONCLUSION An increase in reimbursement for ambulance transportation acceptance was associated with a decrease in the number of EMS calls. Further strategies for decreasing the number of EMS calls are needed to avoid delays in the treatment of emergency patients with critical illness.
Collapse
Affiliation(s)
- Nobuhiro Sato
- Department of Emergency and Critical Care Medicine, Niigata City General Hospital, Niigata, Niigata, Japan
| | - Reo Takaku
- Graduate School of Economics, Hitotsubashi University, Kunitachi, Tokyo, Japan
| | - Takuyo Chiba
- Department of Emergency Medicine, International University of Health and Welfare, Narita, Chiba, Japan
| | - Hidenori Higashi
- Department of Emergency and Critical Care Medicine, Japanese Red Cross Wakayama Medical Center, Wakayama, Wakayama, Japan
| | - Takashi Shiga
- Department of Emergency Medicine, International University of Health and Welfare, Narita, Chiba, Japan
| |
Collapse
|
6
|
Yamada H, Neshige S, Nonaka M, Takebayashi Y, Ishibashi H, Motoda A, Aoki S, Yamazaki Y, Maruyama H. On-scene time delays for epileptic seizures in emergencies during a social pandemic: A population-based study. Epilepsy Behav 2023; 142:109211. [PMID: 37088065 PMCID: PMC10122515 DOI: 10.1016/j.yebeh.2023.109211] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 03/31/2023] [Accepted: 04/01/2023] [Indexed: 04/25/2023]
Abstract
OBJECTIVES The on-scene time of Emergency Medical Services (EMS), including time for hospital selection, is critical for people in an emergency. However, the outbreak of the novel coronavirus disease 2019 (COVID-19) led to longer delays in providing immediate care for individuals with non-COVID-19-related emergencies, such as epileptic seizures. This study aimed to examine factors associated with on-scene time delays for people with epilepsy (PWE) with seizures needing immediate amelioration. MATERIALS & METHODS We conducted a population-based retrospective cohort study for PWE transported by EMS between 2016 and 2021. We used data from the Hiroshima City Fire Service Bureau database, divided into three study periods: "Pre period", the period before the COVID pandemic (2016-2019); "Early period", the early period of the COVID pandemic (2020); and "Middle period", the middle period of the COVID pandemic (2021). We performed linear regression modeling to identify factors associated with changes in EMS on-scene time for PWE during each period. In addition, we estimated the rate of total EMS call volume required to maintain the same on-scene time for PWE transported by EMS during the pandemic expansion. RESULTS Among 2,205 PWE transported by EMS, significant differences in mean age and prevalence of impaired consciousness were found between pandemic periods. Total EMS call volume per month for all causes during the same month <5,000 (-0.55 min, 95% confidence interval [CI] -1.02 - -0.08, p = 0.022) and transport during the Early period (-1.88 min, 95%CI -2.75 - -1.00, p < 0.001) decreased on-scene time, whereas transport during the Middle period (1.58 min, 95%CI 0.70 - 2.46, p < 0.001) increased on-scene time for PWE transported by EMS. The rate of total EMS call volume was estimated as 0.81 (95%CI -0.04 - 1.07) during the expansion phase of the pandemic to maintain the same degree of on-scene time for PWE transported by EMS before the pandemic. CONCLUSIONS On-scene time delays on PWE in critical care settings were observed during the Middle period. When the pandemic expanded, the EMS system required resource allocation to maintain EMS for time-sensitive illnesses such as epileptic seizures. Timely system changes are critical to meet dramatic social changes.
Collapse
Affiliation(s)
- Hidetada Yamada
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima 734-8551, Japan
| | - Shuichiro Neshige
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima 734-8551, Japan.
| | - Megumi Nonaka
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima 734-8551, Japan
| | - Yoshiko Takebayashi
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima 734-8551, Japan
| | - Haruka Ishibashi
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima 734-8551, Japan
| | - Atsuko Motoda
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima 734-8551, Japan
| | - Shiro Aoki
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima 734-8551, Japan
| | - Yu Yamazaki
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima 734-8551, Japan
| | - Hirofumi Maruyama
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima 734-8551, Japan
| |
Collapse
|
7
|
Foucaud A, Gilbert T, Vincent A, Jomard N, Comte B, Porthault S, Comte G, Theurey O, Gueugniaud PY, Bourelly L, Rabilloud M, Boutitie F, Douplat M, Tassa O, Haesebaert J, Termoz A, Schott AM. Evaluation of a training program for emergency medical service physician dispatchers to reduce emergency departments visits. J Am Geriatr Soc 2023; 71:484-495. [PMID: 36317929 DOI: 10.1111/jgs.18101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 09/08/2022] [Accepted: 09/24/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Emergency Departments (ED) have seen an increasing number of older patients who are mostly referred following a call to the Emergency Medical Services (EMS). Long waiting times in settings, which are not designed to meet older patients' needs, may increase the risk of hospital-acquired complications. Unnecessary visits should therefore be avoided as much as possible. The objective of the study was to evaluate whether a program to provide geriatric knowledge and tools to the dispatching physicians of the EMS could decrease ED referrals of older patients. METHODS Design: Before-and-after study with two 6-month periods before and after intervention. PARTICIPANTS All calls received by a dispatching physician of the Rhône EMS from 8 am to 6 pm concerning patients aged 75 years or above during the study period. INTERVENTION A program consisting of training dispatching physicians in the specific care of older patients and the developing, with a multidisciplinary team, of specific tools for dispatching physicians. OUTCOME Proportion of ED referrals of patients aged 75 years or above after a call to the EMS. RESULTS A total of 2671 calls to the Rhône EMS were included corresponding to 1307 and 1364 patients in the pre-and post-intervention phases, respectively. There was no significant difference in the proportion of referrals to the ED between the pre-intervention (61.7%) and the post-intervention (62.8%) phases (p = 0.57). Contact of the patients with their General Practitioner (GP) in the month preceding the call was associated with a 22% reduced probability of being referred to an ED. CONCLUSIONS No beneficial effect of the intervention was demonstrated. This strategy of intervention is probably not effective enough in such time-constraint environment. Other strategies with a specific parallel dispatching of geriatric calls by geriatricians should be tested to avoid these unnecessary ED referrals. TRIAL REGISTRATION ClinicalTrials NCT02712450.
Collapse
Affiliation(s)
- Amandine Foucaud
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service de Gériatrie, Pierre Bénite, France
| | - Thomas Gilbert
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service de Gériatrie, Pierre Bénite, France.,Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France
| | - Adélaïde Vincent
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Gériatrie, Lyon, France
| | - Nathalie Jomard
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service de Gériatrie, Pierre Bénite, France
| | - Brigitte Comte
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Gériatrie, Lyon, France
| | - Sylvie Porthault
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Hôpital Edouard Herriot, SAMU, Lyon, France
| | - Gaële Comte
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Hôpital Edouard Herriot, SAMU, Lyon, France
| | - Odile Theurey
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Hôpital Edouard Herriot, SAMU, Lyon, France
| | - Pierre-Yves Gueugniaud
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Hôpital Edouard Herriot, SAMU, Lyon, France
| | - Laura Bourelly
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Gériatrie, Lyon, France
| | - Muriel Rabilloud
- Hospices Civils de Lyon, Pôle Santé Publique, Service de Biostatistique et Bioinformatique, Lyon, France.,Laboratoire de Biométrie et Biologie Évolutive, CNRS, UMR 5558, Équipe Biostatistique-Santé, Villeurbanne, France
| | - Florent Boutitie
- Hospices Civils de Lyon, Pôle Santé Publique, Service de Biostatistique et Bioinformatique, Lyon, France
| | - Marion Douplat
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service des Urgences, Pierre Bénite, France
| | - Ouazna Tassa
- Hospices Civils de Lyon, Pôle de Sante Publique, Service Recherche et Épidémiologie Cliniques, Lyon, France
| | - Julie Haesebaert
- Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France.,Hospices Civils de Lyon, Pôle de Sante Publique, Service Recherche et Épidémiologie Cliniques, Lyon, France
| | - Anne Termoz
- Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France.,Hospices Civils de Lyon, Pôle de Sante Publique, Service Recherche et Épidémiologie Cliniques, Lyon, France
| | - Anne-Marie Schott
- Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France.,Hospices Civils de Lyon, Pôle de Sante Publique, Service Recherche et Épidémiologie Cliniques, Lyon, France
| |
Collapse
|
8
|
Profile and Outcome of Victims of an Earthquake in an Aging Society: A Population-Based Descriptive Study of the Earthquake in Osaka, Japan, on June 18, 2018. Disaster Med Public Health Prep 2022; 17:e149. [PMID: 35414369 DOI: 10.1017/dmp.2022.61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The aim of this study is to reveal the characteristics and outcomes of patients injured in a major earthquake and who were transported to a hospital by ambulance. METHODS This study was a retrospective descriptive epidemiological study including all patients who were injured after a major earthquake struck Osaka Prefecture on June 18, 2018, and were transported to a hospital by ambulance. The main outcome was the prognosis at each hospital's emergency department. RESULTS In total, 214 patients were included in the analysis. Their median age was 74 years (IQR, 54-82); 53 (24.8%) were men and 161 (75.2%) were women. The median time from ambulance call to arrival at the scene was 10 min (IQR, 7-15), and the median time from ambulance call to the hospital arrival was 37 min (IQR, 30-51). Ninety-seven patients (45.3%) were admitted to a hospital, 114 patients (53.3%) were discharged home to and from the emergency department, and 3 patients (1.4%) died. Among the patients discharged to home from the emergency department, the most common pathological condition was head bruising in 16 patients. CONCLUSIONS This study revealed the profile of injured patients transported by ambulances after an earthquake that struck an aging society.
Collapse
|
9
|
Nakao S, Katayama Y, Tanaka K, Kitamura T, Hirose T, Tachino J, Iwami T, Shimazu T, Oda J, Matsuoka T. Impact of the
COVID
‐19 pandemic and subsequent social restrictions on ambulance calls for suicidal and nonsuicidal self‐harm: a population‐based study in Osaka prefecture, Japan. Acute Med Surg 2022; 9:e787. [PMID: 36187449 PMCID: PMC9500421 DOI: 10.1002/ams2.787] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 08/30/2022] [Indexed: 11/25/2022] Open
Abstract
Aim Self‐harm is a common ambulance call and is potentially affected by the COVID‐19 pandemic. The aim of this study was to investigate whether the incidence of ambulance transport due to self‐harm increased in 2020. Methods We undertook a population‐based observational study using a database from the Osaka prefectural government. Ambulance transport of patients due to self‐harm from 2016 through 2020 was investigated. We estimated adjusted incidence rate ratios using a Poisson regression model to compare the annual incidence rates of ambulance transport in 2017–2020 with those in 2016. We also provided age‐stratified analysis. Results We analyzed 13,648 patients. There was no difference in the incidence of ambulance transport due to self‐harm in 2017, 2018, 2019, and 2020 compared with 2016. In the age group of 20–29 years, despite no difference in 2017–2019 compared with 2016, we found a 13.8% increase in the incidence of ambulance transport due to self‐harm in 2020 (adjusted incidence rate ratio, 1.138; 95% confidence interval, 1.025–1.265). Conclusions Although there was no difference in the incidence of ambulance transport due to self‐harm in 2017–2019, that in 2020 increased in the age group of 20–29 years.
Collapse
Affiliation(s)
- Shunichiro Nakao
- Department of Traumatology and Acute Critical Medicine Osaka University Graduate School of Medicine Osaka Japan
| | - Yusuke Katayama
- Department of Traumatology and Acute Critical Medicine Osaka University Graduate School of Medicine Osaka Japan
| | - Kenta Tanaka
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine Osaka University Graduate School of Medicine Osaka Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine Osaka University Graduate School of Medicine Osaka Japan
| | - Tomoya Hirose
- Department of Traumatology and Acute Critical Medicine Osaka University Graduate School of Medicine Osaka Japan
| | - Jotaro Tachino
- Department of Traumatology and Acute Critical Medicine Osaka University Graduate School of Medicine Osaka Japan
| | - Taku Iwami
- Department of Preventive Services, School of Public Health Kyoto University Kyoto Japan
| | | | - Jun Oda
- Department of Traumatology and Acute Critical Medicine Osaka University Graduate School of Medicine Osaka Japan
| | | |
Collapse
|
10
|
Nakao S, Katayama Y, Hirayama A, Hirose T, Ishida K, Umemura Y, Tachino J, Kiguchi T, Matsuyama T, Kiyohara K, Kitamura T, Nakagawa Y, Shimazu T. Characteristics and outcomes of pediatric blunt renal trauma: a nationwide cohort study in Japan. Eur J Trauma Emerg Surg 2021; 48:2047-2057. [PMID: 34562135 DOI: 10.1007/s00068-021-01795-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 09/17/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to describe epidemiologic features of pediatric blunt renal trauma. METHODS We performed a retrospective analysis using the Japan Trauma Data Bank over 15 years. We included patients younger than 18 years with blunt renal trauma. We analyzed temporal trends and variations across age groups in patient characteristics, intervention, and in-hospital mortality. We also assessed factors associated with in-hospital mortality. RESULTS We identified 435 pediatric patients with blunt renal trauma. Their median age was 14 years and median Injury Severity Score (ISS) was 17. The most common mechanism of injury was traffic accident in all age groups. Nephrectomy was performed in 3.2%, and the overall in-hospital mortality was 4.6%, both of which showed decreasing trends. The most common mechanism of injury by age group was a pedestrian accident in infants/toddlers/preschoolers (43.5%), pedestrian accident in middle childhood (18.5%), bicycle accident in young teens (24.7%), and motorcycle accident in teenagers (41.2%). Sports-related injury was common in young teens (23.3%) and teenagers (15.2%). Factors such as ISS, shock, concomitant injury, and nephrectomy were associated with high in-hospital mortality. CONCLUSIONS We described decreasing trends in nephrectomy and in-hospital mortality in pediatric blunt renal trauma and found traffic accident and sports-related injury were common in the pediatric population in Japan.
Collapse
Affiliation(s)
- Shunichiro Nakao
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Yusuke Katayama
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Atsushi Hirayama
- Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Tomoya Hirose
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Kenichiro Ishida
- Department of Acute Medicine and Critical Care Medical Center, Osaka National Hospital, National Hospital Organization, Osaka, Japan
| | - Yutaka Umemura
- Department of Emergency and Critical Care, Osaka General Medical Center, Osaka, Japan
| | - Jotaro Tachino
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Takeyuki Kiguchi
- Department of Emergency and Critical Care, Osaka General Medical Center, Osaka, Japan
- Kyoto University Health Service, Kyoto, Japan
| | - Tasuku Matsuyama
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kosuke Kiyohara
- Department of Food Science, Faculty of Home Economics, Otsuma Women's University, Tokyo, Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Yuko Nakagawa
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Takeshi Shimazu
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
- Department of Emergency and Critical Care, Osaka General Medical Center, Osaka, Japan
| |
Collapse
|
11
|
Kubo R, Ueda K, Seposo X, Honda A, Takano H. Association between ambient temperature and intentional injuries: A case-crossover analysis using ambulance transport records in Japan. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 774:145511. [PMID: 33609821 DOI: 10.1016/j.scitotenv.2021.145511] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 01/26/2021] [Accepted: 01/26/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Epidemiological studies based on mortality and crime data have indicated that short-term exposure to higher temperature increases the risk of suicide and violent crimes. However, there are few studies on non-fatal intentional injury, especially on non-fatal self-harm which is much more common than suicide. OBJECTIVES We aimed to clarify how short-term exposure to temperature is associated with emergency ambulance transport caused by intentional injuries including acts of self-harm and assault. METHOD We applied a time-stratified case-crossover design using a conditional quasi-Poisson regression model for each of the 46 prefectures. All temperatures were converted to percentile value for each prefecture, to account for the varied climate across Japan. A Distributed Lag Non-Linear Model was used to explore the temperature percentile and lag pattern. The prefecture-specific results were combined using a meta-analysis with the random effects model. RESULT Between 2012 and 2015, the number of acts of self-harm and assault across all 46 prefectures totaled 151,801 and 95,861, respectively. We found that as the temperature increased, the relative risk (RRs) for both self-harm and assault behaviors increased in a nearly linear manner. The pooled relative risk at the 99th percentile temperature for self-harm behavior was 1.11 (95% CI: 1.07, 1.15) compared with the risk at the 1st percentile temperature, and that for assault was 1.12 (95% CI: 1.08, 1.16) at lag 0. The RRs were highest at lag0 and less than 1 at lag7-20. CONCLUSION The present study found that short-term exposure to higher temperature promotes the risk of emergency ambulance transport due to acts of self-harm and assault. The lag pattern indicates a possible "displacement" effect. These results suggest that exposure to high temperatures may potentially function as a trigger for intentional injuries.
Collapse
Affiliation(s)
- Ryusei Kubo
- Department of Environmental Engineering, Graduate School of Engineering, Kyoto University, Kyoto, Japan
| | - Kayo Ueda
- Department of Environmental Engineering, Graduate School of Engineering, Kyoto University, Kyoto, Japan; Graduate School of Global Environmental Studies, Kyoto University, Kyoto, Japan.
| | - Xerxes Seposo
- School of Tropical Medicine and Global Health, Nagasaki University, Japan
| | - Akiko Honda
- Department of Environmental Engineering, Graduate School of Engineering, Kyoto University, Kyoto, Japan; Graduate School of Global Environmental Studies, Kyoto University, Kyoto, Japan
| | - Hirohisa Takano
- Department of Environmental Engineering, Graduate School of Engineering, Kyoto University, Kyoto, Japan; Graduate School of Global Environmental Studies, Kyoto University, Kyoto, Japan
| |
Collapse
|
12
|
Katayama Y, Kitamura T, Kiyohara K, Ishida K, Hirose T, Nakao S, Tachino J, Matsuyama T, Kiguchi T, Umemura Y, Noda T, Nakagawa Y, Shimazu T. Effect of fluid administration on scene to traffic accident patients by EMS personnel: a propensity score-matched study using population-based ambulance records and nationwide trauma registry in Japan. Eur J Trauma Emerg Surg 2021; 48:999-1007. [PMID: 33492423 PMCID: PMC9001559 DOI: 10.1007/s00068-020-01590-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 12/27/2020] [Indexed: 11/25/2022]
Abstract
Purpose The aim of this study was to assess the effect of fluid administration by emergency life-saving technicians (ELST) on the prognosis of traffic accident patients by using a propensity score (PS)-matching method. Methods The study included traffic accident patients registered in the JTDB database from January 2016 to December 2017. The main outcome was hospital mortality, and the secondary outcome was cardiopulmonary arrest on hospital arrival (CPAOA). To reduce potential confounding effects in the comparisons between two groups, we estimated a propensity score (PS) by fitting a logistic regression model that was adjusted for 17 variables before the implementation of fluid administration by ELST at the scene. Results During the study period, 10,908 traffic accident patients were registered in the JTDB database, and we included 3502 patients in this study. Of these patients, 142 were administered fluid by ELST and 3360 were not administered fluid by ELST. After PS matching, 141 patients were selected from each group. In the PS-matched model, fluid administration by ELST at the scene was not associated with discharge to death (crude OR: 0.859 [95% CI, 0.500–1.475]; p = 0.582). However, the fluid group showed statistically better outcome for CPAOA than the no fluid group in the multiple logistic regression model (adjusted OR: 0.231 [95% CI, 0.055–0.967]; p = 0.045). Conclusion In this study, fluid administration to traffic accident patients by ELST was associated not with hospital mortality but with a lower proportion of CPAOA.
Collapse
Affiliation(s)
- Yusuke Katayama
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15, Yamada-oka, Suita, 565-0871, Japan.
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, 2-15, Yamada-oka, Suita, Japan
| | - Kosuke Kiyohara
- Department of Food Science, Faculty of Home Economics, Otsuma Women's University, 12, Sanban-cho, Chiyoda-ku, Tokyo, Japan
| | - Kenichiro Ishida
- Department of Acute Medicine and Critical Care Medical Center, Osaka National Hospital, National Hospital Organization, 2-1-14, Hoenzaka, Chuo-ku, Osaka, Japan
| | - Tomoya Hirose
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15, Yamada-oka, Suita, 565-0871, Japan
| | - Shunichiro Nakao
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15, Yamada-oka, Suita, 565-0871, Japan
| | - Jotaro Tachino
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15, Yamada-oka, Suita, 565-0871, Japan
| | - Tasuku Matsuyama
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, 465 Kajiicho, Hiroko-ji Noboru, Kawaramachi-dori, Kamigyo-ku, Kyoto, Japan
| | - Takeyuki Kiguchi
- Division of Trauma and Surgical Critical Care, Osaka General Medical Center, 3-1-56, Mandai-higashi, Sumiyoshi-ku, Osaka, Japan.,Kyoto University Health Services, Yoshida-honmachi, Sakyo-ku, Kyoto, Japan
| | - Yutaka Umemura
- Division of Trauma and Surgical Critical Care, Osaka General Medical Center, 3-1-56, Mandai-higashi, Sumiyoshi-ku, Osaka, Japan
| | - Tomohiro Noda
- Department of Traumatology and Critical Care Medicine, Osaka City University Graduate School of Medicine, 1-5-7, Asahi-machi, Abeno-ku, Osaka, Japan
| | - Yuko Nakagawa
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15, Yamada-oka, Suita, 565-0871, Japan
| | - Takeshi Shimazu
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15, Yamada-oka, Suita, 565-0871, Japan
| |
Collapse
|
13
|
Katayama Y, Kiyohara K, Kitamura T, Hirose T, Ishida K, Umemura Y, Kiguchi T, Nakao S, Tachino J, Noda T, Shimazu T. Impact of medical reimbursement revision on ambulance transport of self-inflicted injury patients: a nationwide study in Japan. Acute Med Surg 2021; 8:e693. [PMID: 34589230 PMCID: PMC8459587 DOI: 10.1002/ams2.693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 08/03/2021] [Accepted: 08/28/2021] [Indexed: 11/25/2022] Open
Abstract
AIM Self-inflicted injury, as one reason to visit the emergency department, is an important issue in emergency medicine around the world. However, the impact of changes in social systems, such as medical reimbursement revision, on ambulance transport for self-inflicted injury remains unclear. The aim of this study was to assess the impact of medical reimbursement revision on the emergency transport of self-inflicted injury patients using nationwide ambulance records. METHODS This was a retrospective observational study from April 2012 to March 2016. We analyzed nationwide ambulance records in Japan, and included self-inflicted injury, drug poisoning, and drug overdose patients transported to hospitals by ambulance. The primary outcome of this study was age-adjusted number of self-inflicted injury patients transported by ambulance in each month per 1 million standard populations. To assess the impact of the medical reimbursement revision in 2014, we calculated the R 2, regression coefficients and 95% confidence interval (CI) using interrupted time series analysis. RESULTS This study included 148,873 patients. The R 2 for the interrupted time series model was 0.821. The regression coefficient for the time trend before the medical reimbursement revision was 0.167 (95% CI, 0.090 to 0.244; p < 0.001), that for the time trend after the medical reimbursement revision was -0.226 (95% CI, -0.327 to -0.125, p < 0.001), and that of the medical reimbursement revision was -2.165 (95% CI, -3.730 to -0.601, p = 0.008). CONCLUSION In Japan, the medical reimbursement revision in April 2014 helped to decrease the number of self-inflicted injury patients transported to hospitals by ambulance.
Collapse
Affiliation(s)
- Yusuke Katayama
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineSuitaJapan
| | - Kosuke Kiyohara
- Department of Food ScienceFaculty of Home EconomicsOtsuma Women’s University TokyoTokyoJapan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population SciencesDepartment of Social and Environmental MedicineOsaka University Graduate School of MedicineSuitaJapan
| | - Tomoya Hirose
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineSuitaJapan
| | - Kenichiro Ishida
- Department of Acute Medicine and Critical Care Medical CenterOsaka National HospitalNational Hospital OrganizationOsakaJapan
| | - Yutaka Umemura
- Division of Trauma and Surgical Critical CareOsaka General Medical CenterOsakaJapan
| | - Takeyuki Kiguchi
- Division of Trauma and Surgical Critical CareOsaka General Medical CenterOsakaJapan
- Kyoto University Health ServicesKyotoJapan
| | - Shunichiro Nakao
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineSuitaJapan
| | - Jotaro Tachino
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineSuitaJapan
| | - Tomohiro Noda
- Department of Traumatology and Critical Care MedicineOsaka City University Graduate School of MedicineOsakaJapan
| | - Takeshi Shimazu
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineSuitaJapan
| |
Collapse
|
14
|
Nakao S, Katayama Y, Hirayama A, Hirose T, Ishida K, Umemura Y, Tachino J, Kiguchi T, Matsuyama T, Kiyohara K, Kitamura T, Nakagawa Y, Shimazu T. Trends and outcomes of blunt renal trauma management: a nationwide cohort study in Japan. World J Emerg Surg 2020; 15:50. [PMID: 32847621 PMCID: PMC7448491 DOI: 10.1186/s13017-020-00329-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 08/17/2020] [Indexed: 11/29/2022] Open
Abstract
Background There is a paucity of information for predicting patient outcomes other than the American Association for the Surgery of Trauma (AAST) renal injury scale. The aim of this study was to evaluate the association between the patient characteristics and outcomes of patients with blunt renal trauma using a nationwide database in Japan. Methods We performed a retrospective analysis of the Japan Trauma Data Bank (JTDB) from 2004 to 2018. We identified patients with blunt renal trauma by AIS codes converted to AAST grades. We evaluated trends in patient characteristics and management and assessed factors associated with mortality and nephrectomy using a multivariable logistic regression analysis. Results We identified 3550 patients with blunt renal trauma. Their median age was 43 years and 74.2% were male. Nephrectomy was performed in 3.8%, and the overall mortality rate was 9.5%. We found increasing trends in age and emergency abdominal angiography and decreasing trends in nephrectomy and mortality over the 15-year period. The following factors were associated with mortality: age ≥ 65 years (adjusted OR 3.36); pedestrian accident (adjusted OR 1.94); fall from height (adjusted OR 1.91); shock on arrival (adjusted OR 4.02); concomitant injuries to the head/neck (adjusted OR 3.14), pelvis/lower-extremity (adjusted OR 1.59), liver (adjusted OR 1.68), spleen (adjusted OR 1.45), and gastrointestinal tract (adjusted OR 1.90); AAST grades III–V (adjusted ORs 1.42, 2.16, and 5.55); and emergency abdominal angiography (adjusted OR 0.70). The following factors were associated with nephrectomy: shock on arrival (adjusted OR 1.98), concomitant injuries to the thorax (adjusted OR 0.46) and spleen (adjusted OR 2.07), AAST grades III, IV, and V (adjusted ORs 18.40, 113.89, and 468.17), and emergency abdominal angiography (adjusted OR 0.28). Conclusions We demonstrated that the AAST grade and emergency angiography were associated with mortality and nephrectomy in blunt renal trauma in the Japanese population.
Collapse
Affiliation(s)
- Shunichiro Nakao
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Suita, Osaka, 565-0871, Japan.
| | - Yusuke Katayama
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Suita, Osaka, 565-0871, Japan
| | - Atsushi Hirayama
- Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Tomoya Hirose
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Suita, Osaka, 565-0871, Japan
| | - Kenichiro Ishida
- Department of Acute Medicine and Critical Care Medical Center, Osaka National Hospital, National Hospital Organization, Osaka, Japan
| | - Yutaka Umemura
- Department of Emergency and Critical Care, Osaka General Medical Center, Osaka, Japan
| | - Jotaro Tachino
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Suita, Osaka, 565-0871, Japan
| | | | - Tasuku Matsuyama
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kosuke Kiyohara
- Department of Food Science, Faculty of Home Economics, Otsuma Women's University, Tokyo, Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Yuko Nakagawa
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Suita, Osaka, 565-0871, Japan
| | - Takeshi Shimazu
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Suita, Osaka, 565-0871, Japan
| |
Collapse
|