Factors Affecting Death and Severe Injury in Child Motor Vehicle Passengers

Epidemiology and outcome analysis of blast injury patients in Japan: An analysis of the nationwide trauma registry database

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.

Increased CT Use and No Change in Injury Severity among Child Motor Vehicle Victims: A National Trauma Database Study in Japan

The number of fatalities associated with traffic accidents has been declining owing to improvements in vehicle safety performance and changes in the law. However, injuries in children can lead to social and economic losses. We examined 10-year changes in the characteristics of traffic trauma among pediatric motor vehicle passengers by analyzing data from the Japan Trauma Data Bank (JTDB). Among the 36,715 injured motor vehicle passengers under the age of 15 years who were registered in the JTDB from 2004 to 2019, we compared the groups injured during 2004-2007 (n = 94) and 2017-2019 (n = 203). Physiologically, the 2004-2007 group had a lower body temperature and Glasgow Coma Scale score as well as a higher mortality. Anatomical severity was higher in the 2004-2007 group for the head, face, and neck, according to the Abbreviated Injury Scale. In terms of treatment, only craniotomy as a primary surgery was significantly lower in the 2017-2019 group. The 2017-2019 group had significantly higher rates of receiving whole-body computed tomography (CT). Because the rate of performing CT has increased, with no changes in the injury severities of the trunk and extremities, limiting the number of CT examinations is suggested for pediatric motor vehicle passengers involved in road traffic collisions. The severity of trunk and extremity injuries has not improved in more than 10 years; further preventive measures for these injuries should be considered.

Physiological status and anatomical severity factors associated with child versus adult bicyclist fatalities based on a national trauma dataset

Bicyclists still account for the majority of child deaths in traffic accidents, despite a gradual decrease in incidence. Therefore, we investigated factors associated with child and adult bicyclist fatalities. In this retrospective study, we used data from a national hospital-based database, the Japan Trauma Data Bank. Data from 2004 to 2019 were obtained for child cyclists (5-18 years; n = 4832) and adult cyclists (26-45 years; n = 3449). In each age group, physiological variables, outcomes, and injury severity were compared between fatal and non-fatal cases. Multivariate logistic regression was performed to determine factors associated with fatality. In adults, fatality was associated with lower values for body temperature, Glasgow Coma Scale score, and Abbreviated Injury Scale (AIS) score for the neck and upper extremities, and with higher values for respiratory rate, heart rate, focused assessment with sonography for trauma positivity rate, and AIS scores for the head, chest, and abdomen. In children, fatality was associated with lower values for body temperature and the Glasgow Coma Scale score, and with higher values for the AIS chest score. These findings point to factors associated with bicyclist fatalities and may help in the development of effective strategies to reduce these fatalities.