From the Department of Traumatology and Acute Critical Medicine (J.T., Y.K., S.N., T.H., Y.N., T.S.), Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine (T.K.), Osaka University Graduate School of Medicine, Suita; Department of Food Science, Faculty of Home Economics (K.K.), Otsuma Women's University Tokyo, Tokyo; Department of Emergency and Critical Care (Y.U.), Osaka General Medical Center; and Department of Acute Medicine and Critical Care Medical Center (K.I.), Osaka National Hospital, National Hospital Organization, Osaka, Japan.
J Trauma Acute Care Surg. 2021 Jan 1;90(1):185-190. doi: 10.1097/TA.0000000000002969.
There have been no clinical studies to sufficiently reveal the interaction effect generated by combinations of injury regions of multiple injuries. We hypothesized that certain combinations of trauma regions might lead to increased risk of traumatic death and aimed to verify this hypothesis using a nationwide trauma registry in Japan.
This was a retrospective study of trauma patients registered in the Japan Trauma Data Bank between 2004 and 2017. We included patients who suffered blunt trauma with an Injury Severity Score of 16 or more. The trauma was classified into four regions (head, chest, abdomen, and extremities), and a multivariable logistic regression analysis was performed that included interaction terms derived from the combination of two regions as covariates.
We included 78,280 trauma patients in this study. Among them, 16,100 (20.6%) patients were discharged to death. Multivariable logistic regression showed the odds ratio (OR) of in-hospital death compared with patients without injury of an Abbreviated Injury Scale score of 3 or more in each injured region as follows: head score, 2.31 (95% confidence interval [CI], 2.13-2.51); chest score, 2.28 (95% CI, 2.17-2.39); abdomen score, 1.68 (95% CI, 1.56-1.82); and extremities score, 1.84 (95% CI, 1.76-1.93), respectively. In addition, the ORs of the statistically significant interaction terms were as follows: head-chest 1.29 (95% CI, 1.13-1.48), chest-abdomen 0.77 (95% CI, 0.67-0.88), chest-extremities 1.95 (95% CI, 1.77-2.14), and abdomen-extremities 0.70 (95% CI, 0.62-0.79), respectively.
In this population, among patients with multiple injuries, a combination of head-chest trauma and chest-extremities trauma was shown to increase the risk of traumatic death.
Prognostic, Level III.
目前尚无临床研究充分揭示多发伤中多个损伤区域组合产生的相互作用效应。我们假设某些创伤区域的组合可能会增加创伤死亡的风险，并旨在使用日本全国创伤登记处来验证这一假设。
这是一项对 2004 年至 2017 年间登记在日本创伤数据库中的创伤患者进行的回顾性研究。我们纳入了损伤严重度评分（ISS）≥16 分的钝器伤患者。创伤分为四个区域（头、胸、腹和四肢），并进行了多变量逻辑回归分析，其中包括作为协变量的两个区域组合得出的交互项。
本研究共纳入 78280 例创伤患者。其中，16100 例（20.6%）患者出院时死亡。多变量逻辑回归显示，与每个损伤区域的损伤严重度评分（ISS）为 3 或以上的无损伤患者相比，院内死亡的优势比（OR）如下：头区评分，2.31（95%置信区间[CI]，2.13-2.51）；胸部评分，2.28（95% CI，2.17-2.39）；腹部评分，1.68（95% CI，1.56-1.82）；四肢评分，1.84（95% CI，1.76-1.93）。此外，统计学意义上的交互项的 OR 分别为：头胸 1.29（95% CI，1.13-1.48）、胸腹 0.77（95% CI，0.67-0.88）、胸四肢 1.95（95% CI，1.77-2.14）和腹四肢 0.70（95% CI，0.62-0.79）。
在本研究人群中，多发伤患者中头胸创伤与胸四肢创伤的组合会增加创伤死亡的风险。
预后，III 级。
