Increased CT Use and No Change in Injury Severity among Child Motor Vehicle Victims: A National Trauma Database Study in Japan
Abstract
:1. Introduction
2. Purpose
3. Materials and Methods
3.1. Study Design and Patient Selection
3.2. Statistical Analysis
3.3. Endpoint
4. Results
4.1. Comparison of Patient Characteristics and Information Obtained at Hospital Arrival
4.2. Comparisons of Medical Interventions
5. Discussion
6. Conclusions
7. Limitation
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Miller, T.R.; Romano, E.O.; Spicer, R.S. The cost of childhood unintentional injuries and the value of prevention. Future Child. 2000, 10, 137–163. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Selassie, A.W.; Zaloshnja, E.; Langlois, J.A.; Miller, T.; Jones, P.; Steiner, C. Incidence of long-term disability following traumatic brain injury hospitalization, United States, 2003. J. Head Trauma Rehabil. 2008, 23, 123–131. [Google Scholar] [CrossRef] [Green Version]
- Krzysztof, G.; Mariusz, G.; Witold, P.; Piotr, F. Management of child injuries in traffic and other accident: The WHO policy guidelines. Health Prob. Civil. 2018, 12, 157–162. [Google Scholar] [CrossRef]
- Cabinet Office, Government of Japan. Basic Traffic Safety Plan. Available online: https://www8.cao.go.jp/koutu/taisaku/r02kou_haku/zenbun/genkyo/feature/feature_01_2.html (accessed on 13 January 2023).
- Japan Trauma Care and Research. Japan Trauma Data Bank Annual Report 2011–2015. Available online: http//www.jtcr-jatec.org/traumabank/dataroom/date/JTDB2016.pdf (accessed on 18 January 2023).
- Yumoto, T.; Mitsuhashi, T.; Yamakawa, Y.; Iida, A.; Nosaka, N.; Tsukahara, K.; Naito, T.; Nakao, A. Impact of Cushing’s sign in the prehospital setting on predicting the need for immediate neurosurgical intervention in trauma patients: A nationwide retrospective observational study. Scand. J. Trauma Resusc. Emerg. Med. 2016, 24, 147. [Google Scholar] [CrossRef] [Green Version]
- Shoko, T.; Shiraishi, A.; Kaji, M.; Otomo, Y. Effect of pre-existing medical conditions in hospital mortality: Analysis of 20,257trauma patients in Japan. J. Am. Coll. Surg. 2010, 211, 338–346. [Google Scholar] [CrossRef]
- Japan Trauma Date Bank Report 2020. Available online: https://www.jtcr-jatec.org/traumabank/dataroom/data/JTDB2020e.pdf (accessed on 23 August 2020).
- Spering, C.; Müller, G.; Füzesi, L.; Bouillon, B.; Rüther, H.; Lehmann, W.; Lefering, R.; Section of Injury Prevention DGOU; TraumaRegister DGU. Prevention of severe injuries of child passengers in motor vehicle accidents: Is re-boarding sufficient? Eur. J. Trauma Emerg. Surg. 2022, 48, 3989–3996. [Google Scholar] [CrossRef]
- Ishii, W.; Hitosugi, M.; Takeda, A.; Baba, M.; Iizuka, R. Factors influencing vehicle passenger fatality have changed over 10 years: A nationwide hospital-based study. Sci. Rep. 2020, 10, 3316. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Ishii, W.; Hitosugi, M.; Baba, M.; Kandori, K.; Arai, Y. Factors Affecting Death and Severe Injury in Child Motor Vehicle Passengers. Healthcare 2021, 9, 1431. [Google Scholar] [CrossRef]
- Rebecca, M.; Kate, C.; Shanley, C.; Andrew, H.; Soundappan, S.; Kellie, W.; Daniel, C. Comparative analysis of trends in paediatric trauma outcomes in New South Wales, Australia. Injury 2013, 44, 97–103. [Google Scholar] [CrossRef]
- Mitchell, R.J.; Curtis, K.; Foster, K. A 10-year review of child injury hospitalisations, health outcomes and treatment costs in Australia. Inj. Prev. 2018, 24, 344–350. [Google Scholar] [CrossRef] [Green Version]
- Toida, C.; Muguruma, T.; Gakumazawa, M.; Shinohara, M.; Abe, T.; Takeuchi, I. Ten-year in-hospital mortality trends among Japanese injured patients by age, injury severity, injury mechanism, and injury region: A nationwide observational study. PLoS ONE 2022, 17, e0272573. [Google Scholar] [CrossRef] [PubMed]
- Ehrlich, P.F.; Brown, J.K.; Sochor, M.R.; Wang, S.C.; Eichelberger, M.E. Factors influencing pediatric Injury Severity Score and Glasgow Coma Scale in pediatric automobile crashes: Results from the Crash Injury Research Engineering Network. J. Pediatr. Surg. 2006, 41, 1854–1858. [Google Scholar] [CrossRef]
- Pater, K. OECD iLibrary. J. Bus. Financ. Libarianship 2015, 20, 339–343. [Google Scholar] [CrossRef]
- Huber-Wagner, S.; Biberthaler, P.; Häberle, S.; Wierer, M.; Dobritz, M.; Rummeny, E.; Griensven, M.; Kans, K.G.; Lefering, R.; TraumaRegister DGU. Whole-body CT in hemodynamic unstable severely injured patients—A retrospective, multicenter study. PLoS ONE 2013, 8, e68880. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Huber-Wagner, S.; Lefering, R.; Qvick, L.M.; Korner, M.; Kay, M.V.; Pfeifer, K.J.; Reiser, M.; Mutschler, W.; Kanz, K.G.; Working Group on Polytrauma of the German Trauma Socirty. Effect of whole-body CT during trauma resuscitation on survival: A retrospective, multicentre study. Lancet 2009, 373, 1455–1461. [Google Scholar] [CrossRef] [PubMed]
- Galvagno, S.M.; Haut, E.R.; Zafar, S.N.; Millin, M.G.; Efron, D.T.; Koenig, G.J., Jr.; Baker, S.P.; Bowman, S.M.; Pronovost, P.J.; Haider, A.H. Association between helicopter vs ground emergency medical services and survival for adults with major trauma. JMMA 2012, 307, 1602–1610. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Abe, T.; Takahashi, O.; Saitoh, D.; Tokuda, Y. Association between helicopter with physician versus ground emergency medical services and survival of adults with major trauma in Japan. Crit. Care 2014, 18, R146. [Google Scholar] [CrossRef] [Green Version]
- Caputo, N.D.; Stahmer, C.; Lim, G.; Shah, K. Whole-body computed tomographic scanning leads to better survival as opposed to selective scanning in trauma patients: A systematic review and meta-analysis. J. Trauma Acute Care Surg. 2014, 77, 535–539. [Google Scholar] [CrossRef] [Green Version]
- Jiang, L.; Ma, Y.; Jiang, S.; Ye, L.; Zheng, Z.; Xu, Y.; Zhang, M. Comparison of whole-body computed tomography vs selective radiological imaging on outcomes in major trauma patients: A meta-analysis. Scand. J. Trauma Resusc. Emerg. Med. 2014, 22, 54. [Google Scholar] [CrossRef]
- Runde, D.; Beiner, J. Calculated decisions: PECARN pediatric head injury/trauma algorithm. Emerg. Med. Pract. 2018, 15, CD3–CD4. [Google Scholar]
- Muhm, M.; Danko, T.; Henzler, T.; Luiz, T.; Winkler, H.; Ruffing, T. Pediatric trauma care with computed tomography-criteria for CT scanning. Emerg. Radiol. 2015, 22, 613–621. [Google Scholar] [CrossRef]
- Frush, D.P.; Donnelly, L.F.; Rosen. Computed tomography and radiation risks. Pediatrics 2003, 112, 951–957. [Google Scholar] [CrossRef]
- Brenner, D.J.; Elliston, C.D.; Hall, E.J.; Berdon, W. Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am. J. Roentgenol. 2001, 176, 289–296. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Otero, H.J.; Ondategui-Parra, S.; Erturk, S.M.; Ochoa, R.E.; Gonzalez-Beicos, A.; Ros, P.R. Imaging utilization in the management of appendicitis and its impact on hospital charges. Emerg. Radiol. 2008, 15, 23–28. [Google Scholar] [CrossRef] [PubMed]
- Partrick, D.A.; Janik, J.E.; Janik, J.S.; Bensard, D.D.; Karrer, F.M. Increased CT scan utilization does not improve the diagnostic accuracy of appendi- citis in children. J. Pediatr. Surg. 2003, 38, 659–662. [Google Scholar] [CrossRef]
- Dunning, J.; Daly, J.P.; Lomas, J.P.; Lecky, F.; Batchelor, J.; Mackway-Jones, K. Derivation of the children’s head injury algorithm for the prediction of important clinical events decision rule for head injury in children. Arch. Dis. Child. 2006, 91, 885–891. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Osmond, M.H.; Klassen, T.P.; Wells, G.A.; Correll, R.; Jarvis, A.; Joubert, G.; Bailey, B.; Chauvin-Kimoff, L.; Pusic, M.; McConnell, D.; et al. CATCH: A clinical decision rule for the use of computed tomography in children with minor head injury. CMAJ 2010, 182, 341–348. [Google Scholar] [CrossRef] [Green Version]
- Broder, J.; Warshauer, D.M. Increasing utilization of computed tomography in the adult emergency department, 2000–2005. Emerg. Radiol. 2006, 13, 25–30. [Google Scholar] [CrossRef]
- Selbst, S.M.; Friedman, M.J.; Singh, S.B. Epidemiology and etiology of malpractice lawsuits involving children in U.S. emergency departments and urgent care centers. Pediatr. Emerg. Care 2005, 21, 165–169. [Google Scholar] [CrossRef]
- Abe, T.; Aoki, M.; Deshpande, G.; Sugiyama, T.; Iwagami, M.; Uchida, M.; Nagata, I.; Saitoh, D.; Yamiya, N. Is Whole-Body CT Associated with Reduced In-Hospital Mortality in Children with Trauma? A Nationwide Study. Pediatr. Crit. Care Med. 2019, 20, e245–e250. [Google Scholar] [CrossRef]
- Kane, N.M.; Cronan, J.J.; Dorfman, G.S.; DeLica, F. Pediatric abdominal trauma: Evaluation by computed tomography. Pediatrics 1988, 82, 11–15. [Google Scholar] [CrossRef] [PubMed]
- Taylor, G.A.; Fallat, M.E.; Potter, B.M.; Eichelberger, M.R. The role of computed tomography in blunt abdominal trauma in children. J. Trauma 1988, 28, 1660–1664. [Google Scholar] [CrossRef] [PubMed]
2004 | 2005 | 2006 | 2007 | 2017 | 2018 | 2019 | |
---|---|---|---|---|---|---|---|
Death cases | 185 | 154 | 134 | 115 | 57 | 69 | 47 |
Casualty cases | 80,770 | 78,654 | 72,752 | 70,098 | 34,563 | 30,208 | 26,589 |
2004 to 2007 Injury Group | 2017 to 2019 Injury Group | p Value | |
---|---|---|---|
(n = 94) | (n = 203) | ||
Age (years) | 6.3 ± 4.3 | 6.8 ± 4.0 | 0.2683 |
Sex (%) | 0.486 | ||
Male | 55.3 | 59.6 | |
Female | 44.7 | 40.4 | |
Seating position (%) | 0.1278 | ||
Front-seat passenger | 34.8 | 26 | |
Rear-seat passenger | 65.2 | 74 | |
Systolic blood pressure (mmHg) | 119.1 ± 21.3 | 115.4 ± 21.1 | 0.1777 |
Diastolic blood pressure (mmHg) | 67.5 ± 17.2 | 70.2 ± 15.3 | 0.1897 |
Heart rate (beats/min) | 116.8 ± 27.9 | 110.6 ± 29.0 | 0.1084 |
Respiration rate (breaths/min) | 26.5 ± 10.2 | 25.3 ± 9.6 | 0.2064 |
Body temperature (°C) | 36.4 ± 1.0 | 36.8 ± 0.8 | <0.0001 |
Glasgow Coma Scale | 12.4 ± 3.6 | 13.5 ± 2.9 | 0.0041 |
FAST positive (%) | 7.5 | 10.3 | 0.4694 |
2004 to 2007 Injury Group | 2017 to 2019 Injury Group | p Value | |
---|---|---|---|
(n = 94) | (n = 203) | ||
AIS, median (IQR) | |||
Head * | 1.0 (0.0–3.0) | 0.0 (0.0–2.0) | 0.0080 |
Face * | 0.0 (0.0–0.0) | 0.0 (0.0–0.0) | 0.0193 |
Neck * | 0.0 (0.0–1.0) | 0.0 (0.0–0.0) | 0.0385 |
Chest | 0.0 (0.0–0.0) | 0.0 (0.0–0.0) | 0.8873 |
Abdomen | 0.0 (0.0–0.0) | 0.0 (0.0–0.0) | 0.9382 |
Spine | 0.0 (0.0–0.0) | 0.0 (0.0–0.0) | 0.7340 |
Upper extremities | 0.0 (0.0–0.0) | 0.0 (0.0–0.0) | 0.3471 |
Lower extremities | 0.0 (0.0–1.0) | 0.0 (0.0–0.0) | 0.1883 |
2004 to 2007 Injury Group | 2017 to 2019 Injury Group | p Value | |
---|---|---|---|
(n = 94) | (n = 203) | ||
ISS, median (IQR) | 9.0 (2.0–20.0) | 9.0 (4.0–17.0) | 0.6884 |
RTS, median (IQR) ** | 7.55 (6.61–7.84) | 7.84 (7.55–7.84) | 0.0009 |
TRISSPs, median (IQR) | 0.99 (0.97–1.00) | 0.99 (0.9–1.00) | 0.5965 |
2004 to 2007 Injury Group | 2017 to 2019 Injury Group | p Value | |
---|---|---|---|
(n = 94) | (n = 203) | ||
CT execution (%) | 76 (81.7) | 174 (86.1) | 0.3268 |
CT (head) | 69 (74.2) | 145 (71.8) | 0.6663 |
CT (neck) | 23 (24.7) | 112 (38.0) | <0.0001 |
CT (chest) | 34 (36.6) | 124 (61.4) | <0.0001 |
CT (abdomen) | 43 (46.2) | 122 (60.4) | 0.0228 |
CT (pelvis) | 26 (28.0) | 106 (52.5) | <0.0001 |
CT (spine) | 5 (5.38) | 61 (30.2) | <0.0001 |
Transfusion within 24 h in admission (%) | 9 (9.57) | 12 (5.91) | 0.0850 |
2004 to 2007 Injury Group | 2017 to 2019 Injury Group | p Value | |
---|---|---|---|
(n = 94) | (n = 203) | ||
Angiography (%) | |||
Head | 0 (0.00) | 0 (0.00) | |
Neck | 0 (0.00) | 0 (0.00) | |
Chest | 0 (0.00) | 1 (0.49) | 0.4955 |
Abdomen | 1 (1.06) | 7 (3.45) | 0.2378 |
Pelvis | 0 (0.00) | 2 (0.99) | 0.3342 |
Spine | 0 (0.00) | 0 (0.00) | |
Primary surgery (%) | |||
Craniotomy | 6 (6.38) | 4 (1.97) | 0.0499 |
Perforator | 1 (1.06) | 3 (1.48) | 0.7734 |
Open thoracotomy | 1 (1.06) | 3 (1.48) | 0.7734 |
Laparotomy | 3 (3.19) | 11 (5.42) | 0.3996 |
Bone fracture | 13 (13.8) | 25 (12.3) | 0.7163 |
Revascularization | 0 (0.00) | 1 (0.49) | 0.4955 |
Hemostasis | 1 (1.06) | 0 (0.00) | 0.1410 |
Limb followed by surgery | 0 (0.00) | 0 (0.00) | |
With laparoscopy | 0 (0.00) | 1 (0.49) | 0.4955 |
TAE | 1 (1.06) | 3 (1.48) | 0.7734 |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Ishii, W.; Hitosugi, M.; Kandori, K.; Miyaguni, M.; Iizuka, R. Increased CT Use and No Change in Injury Severity among Child Motor Vehicle Victims: A National Trauma Database Study in Japan. Healthcare 2023, 11, 1240. https://doi.org/10.3390/healthcare11091240
Ishii W, Hitosugi M, Kandori K, Miyaguni M, Iizuka R. Increased CT Use and No Change in Injury Severity among Child Motor Vehicle Victims: A National Trauma Database Study in Japan. Healthcare. 2023; 11(9):1240. https://doi.org/10.3390/healthcare11091240
Chicago/Turabian StyleIshii, Wataru, Masahito Hitosugi, Kenji Kandori, Michitaro Miyaguni, and Ryoji Iizuka. 2023. "Increased CT Use and No Change in Injury Severity among Child Motor Vehicle Victims: A National Trauma Database Study in Japan" Healthcare 11, no. 9: 1240. https://doi.org/10.3390/healthcare11091240