Department of Traumatology and Critical Care Medicine, National Defense Medical College, Saitama, Japan; Department of Emergency and Acute Medicine, Saitama Medical University International Medical Center, Saitama, Japan.
Department of Traumatology and Critical Care Medicine, National Defense Medical College, Saitama, Japan; Division of Traumatology, Research Institute, National Defense Medical college, Saitama, Japan.
Burns. 2023 Aug;49(5):1096-1102. doi: 10.1016/j.burns.2022.08.001. Epub 2022 Aug 22.
Blast injuries have a variety of mechanisms, with some cases resulting in immediate death and others resulting in burns as a fourth type of blast injury when the energy of the explosion is relatively low. We reported in 2020, as an incidental result, that burns caused by explosions had a higher survival rate than usual burns caused by other mechanisms. The present study confirmed whether or not burns caused by explosions had higher survival rates than those caused by other mechanisms using the Japan Trauma Data Bank (JTDB), a leading nationwide trauma registry in Japan.
Burn patients registered to the JTDB database from January 2004 to March 2019 were analyzed retrospectively. The 338,744 patients registered to the JTDB database published in 2021 were identified. After exclusion, 7127 patients met the criteria for inclusion in this study. Logistic regression analyses were conducted for in-hospital survival rates using patients with burns, including cases complicated by usual trauma and burned patients without usual trauma. The survival rates by External burn grade AIS98 were compared between the explosion group and other cause groups using burn cases without usual trauma.
The cause of the explosion significantly influenced the survival according to logistic regression analyses using burn groups with and without usual trauma. For AIS 4 and 5, we found significant differences between the explosion group and other cause groups in survival rates among burn cases without usual trauma.
The survival rate of patients with burns induced by explosions was higher than that of common burn cases according to analyses based on a burn grade of AIS98 among burn cases without common trauma. Multivariate analyses also showed that explosion burns had a significantly better outcome than those induced by other causes.
爆炸伤具有多种致伤机制，某些情况下会导致即刻死亡，而在爆炸能量相对较低时，则会出现第四种类型的爆炸伤——烧伤。我们曾于 2020 年偶然报告称，与其他机制引起的烧伤相比，爆炸引起的烧伤存活率更高。本研究使用日本创伤数据库（JTDB）证实了爆炸引起的烧伤是否比其他机制引起的烧伤具有更高的存活率，JTDB 是日本领先的全国性创伤登记处。
回顾性分析了 2004 年 1 月至 2019 年 3 月期间登记在 JTDB 数据库中的烧伤患者。2021 年公布的登记在 JTDB 数据库中的 338744 例患者被确定。排除后，符合纳入标准的患者有 7127 例。对包括常规创伤合并烧伤患者和无常规创伤烧伤患者的烧伤患者进行了住院生存率的 logistic 回归分析。使用无常规创伤的烧伤患者，比较了外部烧伤 AIS98 分级的爆炸组和其他原因组的生存率。
根据使用有无常规创伤的烧伤组进行的 logistic 回归分析，爆炸的原因显著影响了生存率。对于 AIS 4 和 5，我们发现无常规创伤的烧伤患者中，爆炸组与其他原因组之间的生存率存在显著差异。
根据无常规创伤烧伤患者的 AIS98 烧伤分级分析，爆炸引起的烧伤患者的存活率高于常见烧伤患者。多变量分析还表明，爆炸烧伤的预后明显优于其他原因引起的烧伤。
