Madokoro Shunsuke, Hirano Yohei, Kondo Yutaka, Okamoto Ken
Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, Chiba, Japan.
Department of Emergency and Disaster Medicine, Juntendo University, Tokyo, Japan.
Medicine (Baltimore). 2024 Dec 27;103(52):e41058. doi: 10.1097/MD.0000000000041058.
Blast injuries in safe countries like Japan are understudied. This study examines nationwide data to reveal unique patterns, hypothesizing differences from conflict zones, and provides baseline insights for improving trauma care and disaster preparedness globally. This retrospective cohort study was conducted between 2004 and 2017 using a nationwide trauma registry in Japan. Data on patients with blast injuries were extracted from the registry and divided into 3 age groups: 0 to 15 years; 16 to 64 years; and 65-years. Data on patient demographics including age, gender, time of injury, cause of injury, and severity such as abbreviated injury scale for each component of the body and injury severity score (ISS) were analyzed among the groups. The examinations, treatment, and mortality were also assessed. The primary outcome of the study was the in-hospital mortality rate. We also performed subgroup analysis of patients with or without inhalation injuries. A total of 523 blast injury patients were treated during the study period. Among these, 18 belonged to the 0-15 year age group, 414 to the 16 to 64 year age group, and 91 to the 65-year age group. Males accounted for 83.4% of all patients. Most injuries were unintentional (56.2%), with all pediatric injuries occurring accidentally. The skin was the most frequently injured body part (84.3%) and a mean injury severity score was 9. Severe injuries (abbreviated injury scale ≥ 3) mainly involved burns. Only a single body area was damaged in 81.5% of all cases. Focused assessment with sonography for trauma was not performed in 66.5% of cases, and computed tomography scanning was not conducted in 67.7%. No surgery was performed in 67.1% of the cases. The overall in-hospital mortality rate was 6.1%, and the emergency department mortality rate was 1.5%. Intensive care unit admission was common (77.4%). Inhalation injuries were present in 31.5% of patients. These patients had higher intensive care unit admission rates (92.1%) compared to those without inhalation injuries (70.7%), and more frequent tracheal intubations (36.4% vs 15.4%). The study clarified the characteristics of blast injuries in Japan.
在日本这样的安全国家，爆炸伤的研究尚不充分。本研究分析全国范围的数据以揭示独特模式，推测与冲突地区的差异，并为改善全球创伤护理和灾难准备工作提供基线见解。这项回顾性队列研究于2004年至2017年期间利用日本全国创伤登记系统开展。从登记系统中提取爆炸伤患者的数据，并将其分为3个年龄组：0至15岁；16至64岁；以及65岁及以上。对各年龄组患者的人口统计学数据进行分析，包括年龄、性别、受伤时间、受伤原因以及严重程度，如身体各部位的简明损伤定级标准和损伤严重程度评分（ISS）。同时评估检查、治疗及死亡率。本研究的主要结局是院内死亡率。我们还对有或无吸入性损伤的患者进行了亚组分析。研究期间共治疗了523例爆炸伤患者。其中，18例属于0至15岁年龄组，414例属于16至64岁年龄组，91例属于65岁及以上年龄组。男性占所有患者的83.4%。大多数损伤为非故意性（56.2%），所有儿科损伤均为意外发生。皮肤是最常受伤的身体部位（84.3%），平均损伤严重程度评分为9分。严重损伤（简明损伤定级标准≥3）主要为烧伤。81.5%的病例仅单个身体部位受损。66.5%的病例未进行创伤重点超声评估，67.7%的病例未进行计算机断层扫描。67.1%的病例未进行手术。总体院内死亡率为6.1% , 急诊科死亡率为1.5%。重症监护病房收治情况常见（77.4%）。31.5%的患者存在吸入性损伤。与无吸入性损伤的患者相比，这些患者的重症监护病房收治率更高（92.1%），气管插管更频繁（36.4%对15.4%）。该研究阐明了日本爆炸伤的特征。
