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Hagiwara A.,National Center for Global Health and Medicine | Kushimoto S.,Tohoku University | Kato H.,National Hospital Organization Disaster Medical Center | Sasaki J.,Keio University | And 12 more authors.
Shock | Year: 2016

Background: This study investigated the effect of a high ratio of fresh frozen plasma (FFP) to red blood cells (RBCs) within the first 6 and 24h after admission on mortality in patients with severe, blunt trauma. Methods: This retrospective observational study included 189 blunt trauma patients with an Injury Severity Score (ISS) ≥16 requiring RBC transfusions within the first 24h. Receiver operating characteristic (ROC) curve analysis was performed to calculate cut-off values of the FFP/RBC ratio for outcome. The patients were then divided into two groups according to the cut-off value. Patient survival was compared between groups using propensity score matching (PSM). Results: The area under the ROC curve was 0.57, and the FFP/RBC ratio was 1.0 at maximum sensitivity (0.57) and specificity (0.67). All patients were then divided into two groups (FFP/RBC ratio ≥1 or <1) and analyzed using PSM and inverse probability of treatment weighting (IPTW). The unadjusted hazard ratio (HR) was 0.44, and the adjusted HR was 0.29. The HR was 0.38 by PSM and 0.41 by IPTW. The survival rate was significantly higher in patients with an FFP/RBC ratio ≥1 within the first 6h. Conclusions: Severe blunt trauma patients transfused with an FFP/RBC ratio ≥1 within the first 6h had an HR of about 0.4. The transfusion of an FFP/RBC ratio ≥1 within the first 6h was associated with the outcomes of blunt trauma patients with ISS ≥16 who need a transfusion within 24h. © 2016 by the Shock Society. Source


Ishikawa K.,Senshu Trauma and Critical Care Center | Nakao S.,Senshu Trauma and Critical Care Center | Murakami G.,Iwamizawa Kojin kai Hospital | Rodriguez-Vazquez J.F.,Complutense University of Madrid | And 3 more authors.
Surgical and Radiologic Anatomy | Year: 2014

Purpose: Recently, the radiological concept of retroperitoneal interfascial planes has been widely accepted to explain the extension of retroperitoneal pathologies. This study aimed to explore embryologically based corroborative evidence, which remains to be elucidated, for this concept. Methods: Using serial or semi-serial transverse sections from 29 human fetuses at the 5th–25th week of fetal age, we microscopically observed the development of the retroperitoneal fasciae and other structures in the retroperitoneal connective tissue. A hypothesis for the formation of the interfascial planes was generated from the developmental study and analysis of retroperitoneal fasciae in computed tomography images from 224 patients. Results: Whereas the loose connective tissue was uniformly distributed in the retroperitoneum by the 9th week, the primitive renal and transversalis fasciae appeared at the 10th–12th week, as previous research has noted. By the 23rd week, the renal fascia, transversalis fascia, and primitive adipose tissue of the flank pad emerged. In addition, the primitive lateroconal fascia, which runs parallel to and close to the posterior renal fascia, emerged between the renal fascia and the adipose tissue of the flank pad. Conversely, pre-existing loose connective tissue was sandwiched between the opposing fasciae and was compressed and narrowed by the developing organs and fatty tissues. Conclusion: Through this developmental study, we provided the hypothesis that the compressed loose connective tissue and both opposed fasciae compose the interfascial planes. Analysis of the thickened retroperitoneal fasciae in computed tomography images supported this hypothesis. Further developmental or histological studies are required to verify our hypothesis. © 2014, Springer-Verlag France. Source


Nakada T.-A.,Senshu Trauma and Critical Care Center | Nakada T.-A.,Chiba University | Masunaga N.,Senshu Trauma and Critical Care Center | Nakao S.,Senshu Trauma and Critical Care Center | And 5 more authors.
American Journal of Emergency Medicine | Year: 2016

Objective Physiological parameters are crucial for the caring of trauma patients. There is a significant loss of prehospital vital signs data of patients during handover between prehospital and in-hospital teams. Effective strategies for reducing the loss remain a challenging research area. We tested whether the newly developed electronic automated prehospital vital signs chart sharing system would increase the amount of prehospital vital signs data shared with a remote trauma center prior to hospital arrival. Methods Fifty trauma patients, transferred to a level I trauma center in Japan, were studied. The primary outcome variable was the number of prehospital vital signs shared with the trauma center prior to hospital arrival. Results The prehospital vital signs chart sharing system significantly increased the number of prehospital vital signs, including blood pressure, heart rate, and oxygen saturation, shared with the in-hospital team at a remote trauma center prior to patient arrival at the hospital (P <.0001). There were significant differences in prehospital vital signs during ambulance transfer between patients who had severe bleeding and non-severe bleeding within 24 hours after injury onset. Conclusions Vital signs data collected during ambulance transfer via patient monitors could be automatically converted to easily visible patient charts and effectively shared with the remote trauma center prior to hospital arrival. The prehospital vital signs chart sharing system increased the number of precise vital signs shared prior to patient arrival at the hospital, which can potentially contribute to better trauma care without increasing labor and reduce information loss during clinical handover. © 2015 Elsevier Inc. All rights reserved. Source


Nakada T.-A.,Senshu Trauma and Critical Care Center | Nakada T.-A.,Chiba University | Nakao S.,Senshu Trauma and Critical Care Center | Mizushima Y.,Senshu Trauma and Critical Care Center | Matsuoka T.,Senshu Trauma and Critical Care Center
Academic Emergency Medicine | Year: 2015

Objectives Whether sex affects the mortality of trauma patients remains unknown. The hypothesis of this study was that sex was associated with altered mortality rates in trauma. Methods A retrospective review of trauma patients' records in the Japan Trauma Data Bank was conducted (n = 80,813) from 185 major emergency hospitals across Japan. The primary outcome variable was in-hospital mortality within 28 days. Secondary outcome variables included serious injuries to different body regions with an Abbreviated Injury Scale of ≥3. Results In the analysis of 80,813 trauma patients, males had significantly greater 28-day mortality compared to females (adjusted p = 0.0072, odds ratio [OR] = 1.14, 95% confidence interval [CI] = 1.06 to 1.23) via logistic regression analysis adjusted for age, mechanism, Injury Severity Score, Revised Trauma Score, and potential preexisting risk factors. Of 10 injury categories examined, sex significantly affected in-hospital 28-day mortality rate in falls (adjusted p < 0.0001, OR = 1.34, 95% CI = 1.19 to 1.52). Further analysis of three fall subcategories by falling distance revealed that male patients who fell from ground level had significantly higher 28-day mortality (adjusted p < 0.0001, OR = 1.75, 95% CI = 1.43 to 2.14) and a significantly greater frequency of serious injury to the head, thorax, abdomen, and spine, but a lower frequency of serious injury to the extremities, compared to female patients. Conclusions Compared to female trauma patients, male trauma patients had greater 28-day mortality. In particular, ground-level falls had a significant sex difference in mortality, with serious injury to different body regions. Sex differences appeared to be important for fatalities from ground-level falls. © 2015 by the Society for Academic Emergency Medicine. Source


Hayakawa M.,Hokkaido University | Maekawa K.,Hokkaido University | Kushimoto S.,Tohoku University | Kato H.,National Hospital Organization Disaster Medical Center | And 21 more authors.
Shock | Year: 2016

Elevated D-dimer level in trauma patients is associated with tissue damage severity and is an indicator of hyperfibrinolysis during the early phase of trauma. To investigate the interacting effects of fibrinogen and D-dimer levels on arrival at the emergency department for massive transfusion and mortality in severe trauma patients in a multicenter retrospective study. This study included 519 adult trauma patients with an injury severity score ≥16. Patients with ≥10 units of red cell concentrate transfusion and/or death during the first 24h were classified as having a poor outcome. Receiver operating characteristic curve analysis for predicting poor outcome showed the optimal cut-off fibrinogen and D-dimer values to be 190mg/dL and 38mg/L, respectively. On the basis of these values, patients were divided into four groups: low D-dimer (<38mg/L)/high fibrinogen (>190mg/dL), low D-dimer (<38mg/L)/low fibrinogen (≤190mg/dL), high D-dimer (≥38mg/L)/high fibrinogen (>190mg/dL), and high D-dimer (≥38mg/L)/low fibrinogen (≤190mg/dL). The survival rate was lower in the high D-dimer/low fibrinogen group than in the other groups. Moreover, the survival rate was lower in the high D-dimer/high fibrinogen group than in the low D-dimer/high fibrinogen and low D-dimer/low fibrinogen groups. High D-dimer level on arrival is a strong predictor of early death or requirement for massive transfusion in severe trauma patients, even with high fibrinogen levels. © 2015 by the Shock Society. Source

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