Japan Trauma Data Bank Report 2012 ( )

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1 Japan Trauma Data Bank Report 212 (27-211) Japan Trauma Care and Research The Japanese Association for the Surgery of Trauma (Trauma Registry Committee) The Japanese Association for Acute Medicine (Committee for Clinical Care Evaluation)

2 Sapporo City General Hospital Nikko Memorial Hospital Sapporo Medical University Hospital Teine Keijinkai Hospital Hokkaido University Hospital Hokuto Hospital Hachinohe City Hospital Hirosaki University School of Medicine & Hospital Akita Red Cross Hospital Iwate Medical University Hospital Kuji Prefectural Hospital Osaki Citizen Hospital Tohoku University Hospital Sendai City Hospital Ishinomaki Red Cross Hospital Ohta Nishinouchi Hospital Aizu Central Hospital Tsukuba Medical Center Hospital Ibaraki Seinan Medical Hospital Mito Medical Center University of Tsukuba Hospital Dokkyo Medical University Hospital Jichi Medical University Hospital Saiseikai Utunomiya Hospital Gunma University Hospital Maebashi Red Cross Hospital Takasaki General Medical Center Saitama Red Cross Hospital Kawaguchi Municipal Medical Center Dokkyo Medical University Koshigaya Hospital National Defense Medical College Hospital Saitama Medical University Medical Center Saitama Medical University International Medical Center Kuki General Hospital Funabashi Municipal Medical Center Asahi Central Hospital Nippon Medical School Chiba Hokusoh Hospital Chiba Emergency Medical Center Kameda General Hospital Kimitsu Chuou Hospital Juntendo University Urayasu Hospital Chiba University Hospital Showa University Hospital Tokyo Metropolitan Hiroo Hospital Musashino Red Cross Hospital Tokyo Medical University Hospital Teikyo University Hospital National Center for Global Health and Medicine Tokyo Women s Medical University Medical Center East National Disaster Medical Center Nippon Medical School Hospital Nippon Medical School Tama Nagayama Hospital Kyorin University Hospital Surugadai Nihon University Hospital Tokyo Women s Medical University Hospital Ohme Municipal General Hospital Nihon University Itabashi Hospital Tokyo Medical and Dental University Hospital Tokyo Metropolitan Bokutoh Hospital Tokyo Medical University Hachioji Medical Center Keio University Hospital St.Luke s International Hospital Tokyo Medical Center Toho University Omori Medical Center Showa University Northern Yokohama Hospital Yokohama Medical Center Nippon Medical School Musashikosugi Hospital Saiseikai Yokohama-city East Hospital St. Marianna University School of Medicine Hospital Kanto Rosai Hospital Yokohama City University Medical Center Tokai University Hospital Showa University Fujigaoka Hospital Kitasato University Hospital Yokosuka General Hospital Uwamachi Yokosuka Kyosai Hospital Yokohama City Minato Red Cross Hospital Shonan Kamakura General Hospital Yokohama Municipal Citizens Hospital Odawara Municipal Hospital Niigata City General Hospital Kanazawa University Hospital Toyama Prefectural Central Hospital Toyama University Hospital Kouseiren Takaoka Hospital Tonami General Hospital Fukui Prefectural Hospital Yamanashi Prefectural Central Hospital Saku Central Hospital Shinshu University Hospital Aizawa Hospital Suwa Red Cross Hospital Iida Municipal Hospital Chuno Kosei Hospital Gifu University Hospital Takayama Red Cross Hospital Ogaki Municipal Hospital Numazu City Hospital Shizuoka Red Cross Hospital Seirei Mikatahara General Hospital Shizuoka Children s Hospital Shizuoka Saiseikai General Hospital Toyohashi Municipal Hospital Aichi Medical University Hospital Nagoya Ekisaikai Hospital Social Insurance Chukyo Hospital Okazaki City Hospital Daiyukai General Hospital Nagoya City University Hospital Fujita Health University Hospital Saiseikai Shigaken Hospital Omihachiman Community Medical Center Kyoto Daini Red Cross Hospital Kyoto Medical Center Rakuwakai Otowa Hospital Osaka Prefectural Senshu Critical Medical Care Center Saiseikai Senri Hospital Hanwa Memorial Hospital Osaka Mishima Emergency Medical Center Kinki University Hospital Figure 1A Names of All Hospitals Submitting Data to the JTDB (N=196, part 1)

3 Kishiwada Tokushukai Hospital Osaka University Hospital Osaka General Medical Center Kansai Medical University Takii Hospital Osaka City University Hospital Osaka General Medical Center Osaka Medical Center Nakakawachi Medical Center of Acute Medicine Kobe University Hospital Hyogo Emergency Medical Center Ehime University Hospital Kochi Medical Center Chikamori Hospital Kurume University Hospital Iizuka Hospital Ohtemachi Hospital Kitakyushu Municipal Yahata Hospital Kyushu University Hospital Kitakyushu General Hospital Kokura Memorial Hospital Saiseikai Fukuoka General Hospital Toyooka Hospital Tajima Emergency & Critical Care Medical Center Fukuoka University Hospital Public Muraoka Hospital St. Maria s Hospital Kansai Rosai Hospital Fukuoka Wajiro Hospital Hyogo Prefectural Nishinomiya Hospital Fukuoka Red Cross Hospital Hyogo Prefectural Kakogawa Medical Center Saga Prefectural Hospital Koseikan Hyogo Prefectural Awaji Hospital Saga University Hospital Hospital of Hyogo College of Medicine Arao Municipal Hospital Nara Prefectural Nara Hospital Kumamoto Red Cross Hospital Nara Medical University Hospital Kumamoto Medical Center Mie University Hospital Saiseikai Kumamoto Hospital Wakayama Medical University Hospital Nagasaki University Hospital Tsuyama Chuo Hospital Kawasaki Medical School Hospital Okayama University Hospital Hiroshima Prefectural Hospital Chugoku Rosai Hospital Hiroshima University Hospital Kure Medical Center Fukuyama City Hospital Yamaguchi University Hospital Kanmon Medical Center Tokuyama Central Hospital Yamaguchi Grand Medical Center Tottori University Hospital Tokushima Prefectural Miyoshi Hospital Tokushima Prefectural Kaifu Hospital Tokushima Prefectural Central Hospital Taoka Hospital Kagawa University Hospital Kagawa Prefectural Central Hospital Ehime Prefectural Central Hospital Nagasaki Medical Center Oita University Hospital Miyazaki Prefectural Miyazaki Hospital Miyazaki University Hospital Miyazaki Zenjinkai Hospital Miyakonojo Regional Medical Center Osumikanoya Hospital Kagoshima City Hospital Okinawa Prefectural Chubu Hospital Urasoe General Hospital Nakagami Hospital Okinawa Prefectural Hokubu Hospital Ryukyu University Hospital Figure 1B Names of All Hospitals Submitting Data to the JTDB (N=196, part 2)

4 Number of Hospitals Figure 2 Number of Hospitals Submitting to the JTDB by Region.

5 Number of Patients Figure3 Number of Patients by Age. Age (years)

6 Number of Patients Male Female Figure4 Patients by Age and Gender. Age (years)

7 Number of Patients Figure 5 Patients by mechanism of injury Traffic accident includes pedestrian victims.

8 Mechanism of injury Patients (n) Patients by mechanism of injury (%) Traffic accident Low-height falls Falls Stab/Cut Fire/Burns Table 5 Patients by mechanism of injury Other blunt/penetrating Sports related injury Compression Machinary Transport, other Falling object Impalement injury 75.9 Gunshot 44.6 Unspecified Total

9 Number of Patients Age (years) Figure 6 Mechanism of injury by range of age

10 Range of Age (yr) Traffic accident (n) % of total range of age (%) Falls (n) % of total range of age (%) Low-height falls (n) % of total range of age (%) Stab/Cut (n) % of total range of age (%) Fire/Burns (n) % of total range of age (%) Other blunt/ pnetrating (n) % of total range of age (%) >= Unspecified Total Table 6 Mechanism of injury by range of age

11 Number of Patients Figure 7 Deaths by Mechanism of injury

12 Figure 8 Case Fatality by Age

13 Figure 9 Case Fatality by Age Case fatality at each age category (Case Fatality = number of deaths divided by the number of patients at each category 1 by age )

14 Figure 1 Case Fatality by Age Case fatality due to motor vehicle accidents and burns and stub/cut increased with age.

15 Number of patients within 1day 2-7days 8-28days over 29days unspecified Length from onset to death in days Figure 11A Proportional distribution of length from onset to fatality The category within 1 day after onset includes CPAOA patients. Total number = 8,73

16 Mechanism of injury Stake Explosive Firearm Sports Machinery Falling objects Transport others Crush Others Cut / piece Fire / burn unspecified Tumbled Fall Motor unspecified over 29days 8-28days 2-7days within 1day Number of patients Figure 11B Proportional distribution of length from onset to fatality, grouped by mechanism of injury Total number = 8,73

17 Motor vehicle accident Fall Tumbled unspecified Fire / burn Cut / piece Others Crush within 1day days days over 29days unspecified Total Transport others Falling objects Machinery Sports Firearm Explosive Stake Total within 1day days days over 29days unspecified Total Others; Other specified and classifiable Table 11B Proportional distribution of length from onset to fatality, grouped by mechanism of injury Total number = 8,73

18 Probability of survival (TRISS method method : 3: 6: 9: 12: 15: This figure includes trauma-induced CPAOA cases. Total number of patients is 1,84. 18: 21: : 24: Length from onset to death in hours Figure 11C Probability of Survival and Length from Onset to Death in Hours

19 Mechanism of injury 661 Firearm Stake 1,1 Explosive 2,551 Transport others 11,856 Falling objects 17,79 Machinery 22,926 Crush 25,914 12,437 Sports 37,994 Others 61,765 Fire / burn Cut / piece 68,485 unspecified 62,128 36,35 Tumbled 4,323 Fall 718,553 Motor vehicle accident 1, 2, 3, 4, 5, Total number of patients is 67,464. Total hospital length of stay of patients are 1,84,752 days. 6, 7, 8, Total hospital length of stay Figure12 Total hospital length of stay by mechanism of Injury

20 Number of patients % of total patients Total hospital LOS in days Average of hospital LOS in days Motor vehicle accident 26, % 718, Fall 14, % 4, Tumbled 14,12 2.9% 36, unspecified 2, % 62, Cut / piece 2,58 3.5% 68, Fire / burn 1, % 61, Others 1, % 37, Sports % 12, Crush % 25, Machinery % 22, Falling objects % 17, Transport, others % 11, Exposive % 2, Stake 65.1% 1, Firearm 31.5% Total 67,464 1,84, LOS; length of stay Other; Other specified and classifiable Table12 Total and average hospital length of stay by mechanism of injury

21 Mechanism of injury Total number of patients is 67,464. Other; Other specified and classifiable Firearm Stake Explosive Transport others Falling objects Machinery Crush Sports Others Fire / burn Cut / piece unspecified Tumbled Fall Motor vehicle accident Average of hospital length of stay in days Figure 13 Average Hospital length of stay by mechanism of injury

22 Unknown (7.1 % 5,615 cases) (4.9 % 3,926 cases) 1-8 (16.8 % 13,339cases) 25-4 (15.3 % 12,146 cases) (19.8 % 15,745 cases) 9-15 (36.2 % 28,85 cases) Figure 14 Patients and Injury Severity Score (ISS) Proportional distribution of patients grouped by categories of the ISS range. Total N=79,576. The number of patients of ISS 9-15 category was the most of all categories.

23 6 N=79,576 5 ISS Age (years) Figure 15 Patients by ISS and Age Number of injured patients grouped by ISS range, at each age from to 15. The peaks of the number of patients based on age distribution were seen at and ages of any ISS categories, and at ages of ISS Total N=79,576.

24 Age Unknown Total Unknown Total ISS Table 15 Patients by ISS and Age

25 Unknown (9. % 78 cases) 1-8 (1.1 % 1 cases) 9-15 (7.9 % 69 cases) (26. % 2,263 cases) (14.4 % 1,255 cases) 25-4 (41.5 % 3,615 cases) Figure 16A Deaths and Injury Severity Score (ISS) Proportional distribution of deaths grouped by categories of ISS range. Total N=8,73. Deaths in ISS 25-4 category were the highest (3,615 cases: 41.5% of all deaths.

26 N=8,73 Case Fatality (%) Unknown Injury Severity Score Figure 16B Case Fatality by Injury Severity Score (ISS) Range Case fatality grouped by ISS range. (Case fatality = number of deaths divided by the number of patients 1 by ISS range). Case fatality was higher in severe trauma category.

27 9 N=7,898 8 Number of Patients 7 ISS Figure 17 Deaths by ISS and Age Age (years) The peak was seen at elderly ages in ISS 16-24, and the category ISS 25-4 and ISS has two peaks at young and elderly ages.

28 Age 85- Unknown Total Unknown 5 Total 16 ISS Table 17 Deaths by ISS and Age

29 14 Total: n= Number of Deaths 1 Male: n=471 8 Female: n= Age(years) Figure18 Deaths by Age and Gender (ISS<=15) Deaths for patients with ISS<=15 for males and females at each age category.

30 1 9 Total: n=7,11 8 Number of Deaths 7 6 Male: n=4,825 5 Female: n=2, Age(years) Figure19 Deaths by Age and Gender (ISS>15) Deaths for patients with ISS>15 for males and females at each age category.

31 8 27,68 Total Hospital LOS in Days Total: n=68,353 14, , ,924 patients 3, ISS Range Figure 2A Total Hospital LOS and Injury Severity Score (ISS) Proportional distribution of total hospital length of stay for patients, grouped by ISS range.

32 4 364,966 Average Hospital LOS in Days 35 11, ,158 27, ,569 89,849 14,997 3,49 Total: n=68, ,583 days 15 1,9241 patients ISS Range Figure 2B Average Hospital LOS and Injury Severity Score Average hospital length of stay for each category of ISS range. (Average hospital length of stay = total hospital length of stay for each ISS range divided by the total number of patients).

33 -.25; 4,135; 5.2% n/a; 22,452; 28.2%.25-.5; 1,674; 2.1%.5-.75; 2,381; 3.% n/a.75-1.; 48,934; 61.5% n=79,576 Figure 21 Patients by Probability of Survival (Ps) Proportional distribution of patients, grouped by each category of Ps. The Ps category(.75-1.) accounted for 61.5% of all cases. Twenty eight percent of cases were missing at least one variable required to calculate Ps. n/a: not assessed due to missing data.

34 -.1; 2,637; 3.3% n/a; 2,649; 3.4% ; 466; 5.4%.9-1.; 578; 6.6%.8-.9; 375; 4.3%.7-.8; 387; 4.4%.6-.7; 393; 4.5%.2-.3; 484; 5.6%.3-.4; 217; 2.5%.4-.5; 328;.5-.6; 189; 3.8% 2.2% n/a n=8,73 Figure 22-A Deaths by Probability of survival (Ps) Proportional distribution of deaths, grouped by each category of Ps. The lowest Ps category (-.1) accounted for 3.3% of all deaths. n/a: not assessed due to missing values.

35 Case fatality Ps Figure 22-B Case Fatality by Probability of Survival (Ps).9-1. n/a n=69,12 Case fatality for each Ps category (Case fatality = the number of deaths divided by the number of patients x 1 for each Ps category). The lowest Ps category (-.1) and the highest Ps category (.9-1.) had the highest fatality 93.3% and the lowest fatality 1.5%, respectively. The trend that the fatality would decrease as Ps increased was observed. Cases without outcome were excluded from this analysis. n/a: not assessed due to missing values.

36 Figure 23 The number of patients in traffic accidents by types of vehicle and age

37 Figure 24 The number of patients in car accident by drivers and passengers and age

38 Figure 25 The number of patients in car accident (driver) by gender and age

39 Figure 26 The number of patients in car accident (passenger) by gender and age

40 Fatality 2 Number of patients Age 2 Number of Deaths Fatality(%) 1 11 1 Fig.27 Number of Deaths and Fatalities of Motor Vehicular Drivers by Age

41 Number of Patients Age Number of Female Deaths Number of Male Deaths 1 11 1 Fig. 28 Number of Deaths of Motor Vehicular Drivers by Age and Genders

42 Other, 467,.6% Assault, 1472, 1.9% Undetermined, 1685, 2.2% Occupant, 4243, 5.5% Self-inflicted, 5657, 7.3% Unintentional, 63636, 82.5% Fig. 29 Proportional distribution of registered patients, groped by intent

43 Other, 42,.5% Assault, 149, 1.7% Undetermined, 446, 5.2% Occupant, 395, 4.6% Self-inflicted, 155, 17.6% Unintentional, 5999, 7.3% Fig. 3 Proportional distribution of deaths, grouped by intent

44 Female persons 35.6 % Male Female Male persons 64.4 % An age unknown excludes Figure 31 Gender proportion of Unintentional and Occupant

45 7 Number of Patients Male 3 Female 2 1 < Age years Figure 32 Unintentional and Occupant by Age and Gender 85-

46 Age Male Female total < Table 32 Unintentional and Occupant by Age and Gender

47 25 Number of Patients 2 15 Male Female 1 5 < Age years Figure 33 Assault by Age and Gender 85-

48 Age Male Female total < Table 33 Assault by Age and Gender

49 4 Female Number of Patients 35 Male Age years Figure 34 Self-inflicted by Age and Gender

50 unkno total wn Age female Male total Table 34 Self-inflicted by Age and Gender

51 Total Hospital LOS in Days Assault Undetermined Other Unknown Unintentional Self-inflicted Figure 35A Total Hospital LOS by Intent Industrial accident was included in the category of Unintentional.

52 Average Hospital LOS in Days Unintentional Self-inflicted Assault Undetermined Other Unknown Figure 35B Average Hospital LOS by Intent Average hospital length of stay in days = total hospital length of stay divided by the number of patients by intent.

53 35, 25, 21,14 2, 17,528 15, 12,713 12,381 9,186 1, 6,14 5, 1,128 Skin / Burns / Other trauma Lower extremities Upper extremities Spine Abdomen / Pelvic contents Thorax Neck Face Head Number of patients 3, 31,29 29,876 Figure 36 Number of Patients with Injured Body Parts based on AIS

54 maxais Unknown 155 maxais 5 5,55 maxais 1 3,938 maxais 2 3,18 maxais 4 8,218 maxais 3 8,544 Figure 37A Head Injury and max AIS Score

55 maxais maxais 4 87 Unknown 24 maxais 2 4,546 maxais 1 7,19 Figure 37B Facial Injury and max AIS Score

56 maxais 4 59 maxais 5 2 Unknown 77 maxais 1 5 maxais 3 24 maxais Figure 37C Neck Injury and max AIS Score

57 maxais 5 2,93 maxais 6 39 Unknown 211 maxais 1 1,9 maxais 2 1,553 maxais 4 6,331 maxais 3 8,743 Figure 37D Thoracic Injury and max AIS Score

58 maxais 4 1,323 maxais maxais 3 2,927 maxais 6 12 Unknown 82 maxais 1 1,32 maxais 2 3,21 Figure 37E Injury of Abdomen/Pelvic Contents and max AIS Score

59 maxais maxais Unknown 57 maxais maxais 4 2,189 maxais 2 5,398 maxais 3 3,143 Figure 37F Spinal Injury and max AIS Score

60 maxais 3 4,19 Unknown 4 maxais 1 4,379 maxais 2 9,126 Figure 37G Injury of Upper Extremities and max AIS Score

61 maxais 4 1,422 maxais 5 1,271 Unknown 17 maxais 1 3,895 maxais 2 6,768 maxais 3 17,836 Figure 37H Injury of Lower Extremities and max AIS Score

62 maxais maxais maxais 6 86 maxais 3 56 maxais maxais 1 4,174 Figure 37I Skin/Burns/Other Trauma and max AIS Score

63 4, 37,929 Number of Patients 35, 3, 25, 2, 17,481 15, 1,879 1, 5,229 5, 569 Number of injury body parts based on AIS region Figure 38 Number of Patients and Injured Body Parts based on AIS 9 2 8 82 7 6 5 4 3 2 1 2,38

64 JAPAN TRAUMA DATA BANK REPORT 212 (27-211) December 15, 212 The Japanese Association for Acute Medicine Chairman: Kaoru Koike, MD The Japanese Association for the Surgery of Trauma Chairman: Tetsuya Sakamoto, MD Task Force: Noriaki Aoki, MD Masato Ueno, MD Yasuyuki Uchida, MD Jun Oda, MD Akio Kimura, MD Daizoh Saitoh, MD Yuichiro Sakamoto, MD Keiji Tanaka, MD Hideo Tohira, MD Shinji Nakahara, MD Munetaka Hayashi, MD Atsuhiro Fukuda, MD Tomohiko Masuno, MD Yoshihiro Yamaguchi, MD

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