• Akira Endo, Atsushi Shiraishi, Hiroki Matsui, Kenichi Hondo, and Yasuhiro Otomo.
• Trauma and Acute Critical Care Medical Center, Medical Hospital, Tokyo Medical and Dental University, Tokyo, Japan. Electronic address: eraeaccm@tmd.ac.jp.
• J. Am. Coll. Surg. 2017 Feb 1; 224 (2): 191-198.e5.

BackgroundStrategies to optimize early trauma care have been introduced in Japan; however, detailed evaluation of the progress achieved has not been reported.Study DesignIn this retrospective observational study, patients registered in the Japanese nationwide trauma registry were stratified according to probability of survival (Ps) > 0.5 or ≤ 0.5, respectively. Mortality rates during the first 2 days and in-hospital mortality rates were compared between early (2004 to 2009) and late cohorts (2010 to 2014) in each group, using mixed effects logistic regression analysis. Improvement in mortality rates during the first 2 days among subgroups were also assessed.ResultsWe analyzed 80,949 patients with Ps > 0.5 (early, 25,917; late, 55,032) and 8,898 patients with Ps ≤ 0.5 (early, 3,511; late, 5,387). Mortality rates during the first 2 days in both groups were significantly reduced (adjusted odds ratio [AOR; 95% CI] 0.61 [0.53 to 0.69] in the Ps > 0.5 group and 0.67 [0.60 to 0.76] in the Ps ≤ 0.5 group). In-hospital mortality rates in both groups were also significantly reduced (AOR [95% CI] 0.70 [0.64 to 0.76] and 0.73 [0.64 to 0.82], respectively). Significant improvements were observed in patients with a Revised Trauma Score ≥ 7 on arrival or an Abbreviated Injury Scale (AIS) of the abdomen ≥ 3. Limited improvements were observed in patients with head AIS ≥ 3 and in patients who underwent thoracotomy.ConclusionsAlthough early trauma care has generally improved, specific progress was variable. Focused panel review of patients with severe head injury or undergoing thoracotomy may be an efficient strategy for further improvement.Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

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