研究者詳細 - 内藤　宏道

論文 - 内藤　宏道

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Characteristics of self-inflicted injury among suicidal patients: analysis of nation-wide trauma registry 査読

Takeshi Nishimura, Hiromichi Naito, Atsunori Nakao, Shinichi Nakayama

Trauma Surgery & Acute Care Open 6 ( 1 ) e000694 - e000694 2021年4月

掲載種別：研究論文（学術雑誌）出版者・発行元：BMJ

<sec><title>Purpose</title>Self-inflicted injury is one of the most common causes of suicide. Extremity injury is thought to occur most frequently among penetrating injury; however, epidemiology among patients attempting suicide is unknown. This study aims to find the characteristics of penetrating self-inflicted trauma patients.

</sec><sec><title>Methods</title>This is a retrospective cohort study of Japanese nation-wide trauma registry (the Japan National Trauma Data Bank) between January 1, 2004 and December 31, 2017. Patients who attempted suicide with penetrating injury were eligible. We evaluated the occurrence of injury based on injury site (neck/face, chest, abdomen, extremity) as a dependent variable and aging as an independent variable using a generalized linear model and compare those groups with spline models.

</sec><sec><title>Results</title>4576 trauma patients were eligible. Excluding patients with missing age, missing survival data, and missing abbreviate injury score, 4183 patients were enrolled in this study. Common injury site is follows: abdomen 1772 patients (42.4%), extremity 1344 patients (32.0%), neck/face 1253 patients (30.0%), and chest 993 patients (23.7%). The occurrence of neck/face injury, chest injury, and abdominal injury increased with age. On contrary, the rate of extremity injury decreased with age.

</sec><sec><title>Conclusions</title>Among self-inflicted trauma patients, abdominal injury was the most common injury, and neck/face injury, chest injury, and abdominal injury were related with aging. On the contrary, the rate of extremity injury decreased as patients’ age progressed.

</sec><sec><title>Level of evidence</title>Retrospective cohort study, Level III.

</sec>

DOI： 10.1136/tsaco-2021-000694

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Takotsubo Cardiomyopathy Caused by Carbon Dioxide Intoxication 国際誌

Haruna Inoue, Takeshi Nishimura, Tsuyoshi Nojima, Hiromichi Naito

Cureus 13 ( 3 ) e14179 2021年3月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Cureus, Inc.

A 49-year-old man transferred to our hospital for dyspnea that developed while transporting significant loads of dry ice, which may have caused potential carbon dioxide intoxication. On admission, he presented hyperventilation and disorientation. Transthoracic echocardiography showed the reduced motion of the anterior wall of the left ventricle with decreased left ventricular ejection fraction. The patient underwent coronary angiography, which did not show apparent coronary arterial stenosis. The electrocardiogram revealed T-wave change and echocardiography results showed the subsided changes on the third hospital day. He was discharged without any symptoms on the fourth hospital day. Our case demonstrates the potential association between carbon dioxide intoxication and Takotsubo cardiomyopathy. Our experience may inform emergency physicians in formulating diagnostic/therapeutic approaches for similar patients experiencing cardiac failure following carbon dioxide intoxication.

DOI： 10.7759/cureus.14179

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Prevalence and predictors of direct discharge home following hospitalization of patients with serious adverse events managed by the rapid response system in Japan: a multicenter, retrospective, observational study 査読国際誌

Takashi Hongo, Hiromichi Naito, Toshifumi Fujiwara, Takaki Naito, Yosuke Homma, Yoshihisa Fujimoto, Morooka Takaya, Yuji Yamamori, Taka‐aki Nakada, Tsuyoshi Nojima, Atsunori Nakao, Shigeki Fujitani, Shinsuke Fujiwara, Masayasu Arai, Eiji Kawamoto, Yoshiki Sento, Yuta Kawase, Kazuma Nagata, Takuro Saito, Masahiro Tamashiro, Kazuhiro Aoki, Atsushi Miyawaki, Tomoyuki Masuyama, Tatsuya Kawasaki, Takuya Kawaguchi, Takahiro Atsumi, Tomoyuki Ikeda, Yoshiro Hayashi, Takanao Otake, Masaru Tobe, Ryosuke Sekine, Takaaki Nakada, Kazuhiko Sugimoto, Hiroshi Onozawa, Kentaro Miyake, Chikaaki Nakamichi, Naraba Hiromu, Jun Makino, Kenzo Ishii, Yasunobu Goto, Hitoshi Kikuchi, Tadaaki Takada, Dai Taguchi, Kenzo Ishii, Eisei Hoshiyama, Hiromichi Miyabe, Masaru Okamoto, Masahiro Koide, Yoichi Kase, Takuya Hashino, Takehiro Niitsu, Hiroshi Kamijo

Acute Medicine & Surgery 8 ( 1 ) e690 2021年1月

担当区分：責任著者記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Wiley

AIM: The rapid response system (RRS) is an in-hospital medical safety system. To date, not much is known about patient disposition after RRS activation, especially discharge home. This study aimed to investigate the prevalence, characteristics, and outcomes of patients with adverse events who required RRS activation. METHODS: Retrospective data from the In-Hospital Emergency Registry in Japan collected from April 2016 to November 2020 were eligible for our analysis. We divided patients into Home Discharge, Transfer, and Death groups. The primary outcome was the prevalence of direct discharge home, and independently associated factors were determined using multivariable logistic regression. RESULTS: We enrolled 2,043 patients who met the inclusion criteria. The prevalence of discharge home was 45.7%; 934 patients were included in the Home Discharge group. Age (adjusted odds ratio [AOR] 0.96; 95% confidence interval [CI], 0.95-0.97), malignancy (AOR 0.69; 95% CI, 0.48-0.99), oxygen administration before RRS (AOR 0.49; 95% CI, 0.36-0.66), cerebral performance category score on admission (AOR 0.38; 95% CI, 0.26-0.56), do not attempt resuscitation order before RRS (AOR 0.17; 95% CI, 0.10-0.29), RRS call for respiratory failure (AOR 0.50; 95% CI, 0.34-0.72), RRS call for stroke (AOR 0.12; 95% CI, 0.03-0.37), and intubation (AOR 0.20; 95% CI, 0.12-0.34) were independently negative, and RRS call for anaphylaxis (AOR 15.3; 95% CI, 2.72-86.3) was positively associated with discharge home. CONCLUSION: Less than half of the in-hospital patients under RRS activation could discharge home. Patients' conditions before RRS activation, disorders requiring RRS activation, and intubation were factors that affected direct discharge home.

DOI： 10.1002/ams2.690

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その他リンク： https://onlinelibrary.wiley.com/doi/full-xml/10.1002/ams2.690

Refractory gastric ulcer due to undisclosed use of topical diclofenac epolamine patches 査読国際誌

Yuta Oda, Hiromichi Naito, Tsuyoshi Nojima, Atsunori Nakao

Acute Medicine & Surgery 8 ( 1 ) e710 2021年1月

担当区分：責任著者記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Wiley

BACKGROUND: Topical forms of nonsteroidal anti-inflammatory drugs (NSAIDs) have been created to lessen systemic adverse effects. In general, they are believed to be well tolerated and appropriate for use as an over-the-counter (OTC) drug. CASE PRESENTATION: A 68-year-old woman visited our clinic due to tarry stool. The patient reported multiple episodes of recurrent bleeding from a gastric ulcer for 2 months and was treated with endoscopic hemostatic clipping. The patient disclosed she had been using a large number of diclofenac patches for more than 3 months. The patient was treated conservatively by discontinuation of diclofenac patches and treatment with a proton pump inhibitor and omeprazole. CONCLUSION: In conclusion, inappropriate use of topical NSAID patches can be a cause of peptic ulcer bleeding. Patients reporting multiple episodes of recurrent bleeding from a gastric ulcer should be questioned, particularly about the use of OTC medications that might include topical NSAID patches.

DOI： 10.1002/ams2.710

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その他リンク： https://onlinelibrary.wiley.com/doi/full-xml/10.1002/ams2.710

State‐of‐the‐art methods for the treatment of severe hemorrhagic trauma: selective aortic arch perfusion and emergency preservation and resuscitation—what is next? 国際誌

Atsuyoshi Iida, Hiromichi Naito, Tsuyoshi Nojima, Tetsuya Yumoto, Taihei Yamada, Noritomo Fujisaki, Atsunori Nakao, Takeshi Mikane

Acute Medicine & Surgery 8 ( 1 ) e641 2021年1月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Wiley

Trauma is a primary cause of death globally, with non-compressible torso hemorrhage constituting an important part of "potentially survivable trauma death." Resuscitative endovascular balloon occlusion of the aorta has become a popular alternative to aortic cross-clamping under emergent thoracotomy for non-compressible torso hemorrhage in recent years, however, it alone does not improve the survival rate of patients with severe shock or traumatic cardiac arrest from non-compressible torso hemorrhage. Development of novel advanced maneuvers is essential to improve these patients' survival, and research on promising methods such as selective aortic arch perfusion and emergency preservation and resuscitation is ongoing. This review aimed to provide physicians in charge of severe trauma cases with a broad understanding of these novel therapeutic approaches to manage patients with severe hemorrhagic trauma, which may allow them to develop lifesaving strategies for exsanguinating trauma patients. Although there are still hurdles to overcome before their clinical application, promising research on these novel strategies is in progress, and ongoing development of synthetic red blood cells and techniques that reduce ischemia-reperfusion injury may further maximize their effects. Both continuous proof-of-concept studies and translational clinical evaluations are necessary to clinically apply these hemostasis approaches to trauma patients.

DOI： 10.1002/ams2.641

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その他リンク： https://onlinelibrary.wiley.com/doi/full-xml/10.1002/ams2.641

Variability of extracorporeal cardiopulmonary resuscitation practice in patients with out‐of‐hospital cardiac arrest from the emergency department to intensive care unit in Japan

Toru Hifumi, Akihiko Inoue, Toru Takiguchi, Kazuhiro Watanabe, Takayuki Ogura, Tomoya Okazaki, Shinichi Ijuin, Ryosuke Zushi, Hideki Arimoto, Hiroaki Takada, Shinichirou Shiraishi, Yuko Egawa, Jun Kanda, Michitaka Nasu, Makoto Kobayashi, Masaaki Sakuraya, Hiromichi Naito, Shunichiro Nakao, Norio Otani, Ichiro Takeuchi, Naofumi Bunya, Takafumi Shimizu, Hirotaka Sawano, Wataru Takayama, Shigeki Kushimoto, Tomohisa Shoko, Makoto Aoki, Takayuki Otani, Yoshinori Matsuoka, Koichiro Homma, Kunihiko Maekawa, Yoshio Tahara, Reo Fukuda, Migaku Kikuchi, Takuo Nakagami, Yoshihiro Hagiwara, Nobuya Kitamura, Kazuhiro Sugiyama, Tetsuya Sakamoto, Yasuhiro Kuroda

Acute Medicine & Surgery 8 ( 1 ) 2021年1月

Incidence and characteristics of medical emergencies related to dental treatment: a retrospective single‐center study 査読国際誌

Kyoichi Obata, Hiromichi Naito, Hiromasa Yakushiji, Takafumi Obara, Kisho Ono, Tsuyoshi Nojima, Kohei Tsukahara, Taihei Yamada, Akira Sasaki, Atsunori Nakao

Acute Medicine & Surgery 8 ( 1 ) e651 2021年1月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Wiley

AIM: Although uncommon, medical emergencies arise in general dental practice. Inadequate data on their severity and frequency makes targeting medical education for general dental practitioners difficult. This also makes planning for unexpected events challenging for practitioners and makes collaborating with emergency physicians burdensome. We aimed to clarify the incidence and characteristics of a dental outpatient department's medical emergencies. METHODS: This single-center, retrospective, observational study was undertaken with patients who visited the dental outpatient department of Okayama University Hospital during the 8-year period. The primary outcome of the study was to identify the incidence and characteristics of medical emergencies in the dental outpatient department. Then we examined the timing of medical emergencies, administered medications, and final disposition (home/admission). RESULTS: During the period, 1,146,929 patients were enrolled. Forty-two patients (0.0037%) were consulted as medical emergencies. More than 60% of the incidents were vasovagal syncope, and dehydration and hypoglycemia were the second most prevalent at 9.5%. The most common types of dental treatments were tooth extraction (45.2%), followed by general dental treatment (28.6%), and other dental surgery such as implant placement (14.3%). Types of medical emergencies occurred equally before, during, and after dental treatment. Antihypertensive agents, sedatives, or glucose were used. For patients with emergencies, 90.5% recovered during the day and returned home, and 9.5% were hospitalized. CONCLUSION: The incidence of medical emergencies was low in our dental outpatient department. Knowledge of basic management principles, regular education for emergency care, and practicing first aid skills are mandatory for safe patient management.

DOI： 10.1002/ams2.651

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その他リンク： https://onlinelibrary.wiley.com/doi/full-xml/10.1002/ams2.651

Cardiac arrest due to liquid nicotine intoxication: a case report

Atsuyoshi Iida, Yuki Fujiwara, Tsuyoshi Nojima, Hiromichi Naito, Atsunori Nakao, Takeshi Mikane

Acute Medicine & Surgery 8 ( 1 ) 2021年1月

Plastic Bronchitis in a Five-Year-Old Boy Treated Using Extracorporeal Membrane Oxygenation; a Case Report. 国際誌

Tsuyoshi Nojima, Hiromichi Naito, Takafumi Obara, Kohei Tsukahara, Atsunori Nakao

Archives of academic emergency medicine 9 ( 1 ) e16 2021年

記述言語：英語

Plastic bronchitis is an uncommon disorder marked by the production of bronchial casts and acute respiratory failure development. In pediatric cases, influenza infection sometimes results in the obstruction of bronchi and leads to this potentially life-threatening condition. We report the case of a five-year-old boy with plastic bronchitis related to influenza A infection, which could only be recovered by the use of extracorporeal membrane oxygenation (ECMO). ECMO could effectively provide sufficient oxygenation for patients suffering from severe reversible acute respiratory failure. If patients infected with the influenza virus present acute respiratory distress with total lung atelectasis, clinicians should consider the diagnosis of plastic bronchitis and the subsequent treatment interventions with ECMO in a severe cases.

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すべての心停止後患者の社会復帰を目指して院外心停止による心停止後症候群の中期の神経症状改善に関して

内藤宏道, 湯本哲也, 野島剛, 藤崎宣友, 薬師寺泰匡, 中尾篤典

日本救急医学会雑誌 31 ( 11 ) 712 - 712 2020年11月

疑い症例を含むCOVID-19対応下での緊急手術、準備は出来ているか?

山田太平, 小出恭大, 野島剛, 山本浩継, 藤崎宣友, 内藤宏道, 多河慶泰, 高岡諒, 古賀仁士, 山下寿, 中尾篤典

日本救急医学会雑誌 31 ( 11 ) 2220 - 2220 2020年11月

外傷性心停止例の搬送時間と生存率の検討

内藤宏道, 湯本哲也, 野島剛, 頼藤貴志, 中尾篤典

J-ReSS 12 16 - 16 2020年7月

Pediatric airway compromise due to thyroid storm associated with influenza A infection: A case report 国際誌

Taiki Higaki, Kohei Tsukahara, Takafumi Obara, Tsuyoshi Nojima, Hirotsugu Yamamoto, Takaaki Osako, Hiromichi Naito, Atsunori Nakao

Respiratory Medicine Case Reports 31 101182 - 101182 2020年

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Elsevier BV

Thyroid storm is a potentially fatal intensification of thyrotoxicosis normally marked by tachycardia, hyperthermia, impaired mental status, and severe agitation. It can be initiated by numerous causes. Failure to promptly diagnose the condition may lead to high mortality. Early diagnosis and treatment of thyroid storm are essential to prevent further life-threatening complications. A 10-year-old girl was admitted to our emergency center for intensive care. The patient presented tachypnea with stridor, paradoxical abdominal breathing, and "barking" cough. The patient was diagnosed as upper airway obstruction complicated by thyroid storm associated with influenza infection. Following immediate airway management, the patient was administered a short-acting beta-blocker, hydrocortisone, thiamazole, and saturated solution of potassium iodide was initiated. The patient was extubated on day 8 and transferred to a local hospital on day 11 without adverse complications. When examining patients with influenza infection, emergency doctors should be more attentive not to miss other critical diagnoses. The present case was initially diagnosed as croup due to influenza infection. Sharing our experience may help emergency physicians treat similar cases of pediatric airway compromise due to thyroid storm.

DOI： 10.1016/j.rmcr.2020.101182

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Three-year-old traumatic liver injury patient treated successfully using transcatheter arterial embolization 国際誌

Atsuyoshi Iida, Tsuyoshi Ryuko, Masaichi Kemmotsu, Hiroaki Ishii, Hiromichi Naito, Atsunori Nakao

International Journal of Surgery Case Reports 70 205 - 208 2020年

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Elsevier BV

INTRODUCTION: Liver injury is the most vulnerable to blunt abdominal trauma. Diagnostic evaluation and treatment of blunt liver trauma in children have changed essentially over the last decades. PRESENTATION OF CASE: A 3-year-old girl, weighing 10 kg was run over by a car and admitted to our hospital. Due to the liver injury and increased intra-abdominal hemorrhage confirmed by computed tomography, emergent transcatheter arterial embolization (TAE) was performed. Hemostasis was successfully obtained without complications. The patient had a good postoperative course and was discharged on the 9th day after admission. DISCUSSION: To the best of our knowledge, this case is the youngest and lowest weight emergency TAE success cases of childhood liver injury. TAE is an alternative to laparotomy and a useful procedure to accomplish nonsurgical management in adult who are hemodynamically stable and have no other associated injury requiring laparotomy. On the other hand, TAE is considered to have some complications in child cases because of the small diameter of the artery and the tendency to spasm. Our case showed that TAE can be a safe option for emergency hemostasis in pediatric trauma cases weighing 10 kg. CONCLUSION: Emergency physicians must be aware that radiological intervention is an important adjunct to management of childhood liver injury.

DOI： 10.1016/j.ijscr.2020.04.036

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Comparison of two different intensive care unit systems for severely ill children in Japan: Data from the JaRPAC registry 査読

Kohei Tsukahara, Hiromichi Naito, Takashi Yorifuji, Nobuyuki Nosaka, Hirotsugu Yamamoto, Takaaki Osako, Atsunori Nakao, JaRPAC Study Group

Acta Medica Okayama 74 ( 4 ) 285 - 291 2020年

担当区分：責任著者記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Okayama University

The importance of centralizing treatment services for severely ill children has been well established, but such centralization remains difficult in Japan. We aimed to compare the trauma and illness severity and mortality of children admitted to two common types of ICUs for children. According to the type of management and disposition of the medical provider, we classified ICUs as pediatric ICUs [PICUs] or general ICUs, and analyzed differences in endogenous and exogenous illness settings between them. Overall, 1,333 pediatric patients were included, with 1,143 patients admitted to PICUs and 190 patients to general ICUs. The Pediatric Cerebral Performance Category score (PCPC) at discharge was significantly lower in the PICU group (adjusted OR: 0.45
95%CI: 0.23-0.88). Death and unfavorable neurological outcomes occurred less often in the PICU group (adjusted OR: 0.29
95%CI: 0.14-0.60). However, when limited to exogenous illness, PCPC scores (adjusted OR: 0.38
95%CI: 0.07-1.99) or death/unfavorable outcomes (adjusted OR: 0.72
95%CI: 0.08-6.34) did not differ between the groups. PCPC deterioration and overall sequelae/death rates were lower in PICUs for children with endogenous illnesses, although the outcomes of exogenous illness were similar between the 2 unit types. Further studies on the necessity of centralization are warranted.

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Factors Affecting the Absorption of Midazolam to the Extracorporeal Membrane Oxygenation Circuit. 査読

Atsuyoshi Iida, Hiromichi Naito, Takashi Yorifuji, Yoshito Zamami, Akane Yamada, Tadashi Koga, Toru Imai, Toshiaki Sendo, Atsunori Nakao, Shingo Ichiba

Acta medica Okayama 73 ( 2 ) 101 - 107 2019年4月

記述言語：英語掲載種別：研究論文（学術雑誌）

Sedatives are administered during extracorporeal membrane oxygenation (ECMO) therapy to ensure patient safety, reduce the metabolic rate and correct the oxygen supply-demand balance. However, the concentrations of sedatives can be decreased due to absorption into the circuit. This study examined factors affecting the absorption of a commonly used sedative, midazolam (MDZ). Using multiple ex vivo simulation models, three factors that may influence MDZ levels in the ECMO circuit were examined: polyvinyl chloride (PVC) tubing in the circuit, use of a membrane oxygenator in the circuit, and heparin coating of the circuit. We also assessed changes in drug concentration when MDZ was re-injected in a circuit. The MDZ level decreased to approximately 60% of the initial concentration in simulated circuits within the first 30 minutes. The strongest factor in this phenomenon was contact with the PVC tubing. Membrane oxygenator use tended to increase MDZ loss, whereas heparin circuit coating had no influence on MDZ absorption. Similar results were obtained when a second dose of MDZ was injected to the second-use circuits.

DOI： 10.18926/AMO/56645

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Gastric Emphysema in a Critically Ill Patient Successfully Treated without Surgery 国際誌

Hiromi Ihoriya, Tetsuya Yumoto, Masaya Iwamuro, Noritomo Fujisaki, Takaaki Osako, Hiromichi Naito, Atsunori Nakao

Case Reports in Critical Care 2019 1 - 4 2019年3月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Hindawi Limited

Gastric emphysema is a relatively rare clinical entity caused by injury to the gastric mucosa. A 62-year-old Japanese male with a history of heavy alcohol consumption and smoking was admitted to the emergency intensive care unit due to severe hypercapnic respiratory acidosis. His body mass index was only 12.6. Ten days after initiation of enteral feeding, he complained of abdominal pain. Computed tomography revealed intraluminal air in the distended gastric wall. Esophagogastroduodenoscopy showed diffuse edema, redness, and erosion throughout the stomach. Based on the findings of narrow angle and short distance of the aorta-superior mesenteric artery, the patient was diagnosed with gastric emphysema associated with superior mesenteric artery syndrome. He was successfully managed nonoperatively with treatments including intravenous antibiotics, gastric decompression, and bowel rest. Physicians should be aware of this unusual condition in such critically ill patients complaining of abdominal pain and needing close monitoring and observation to exclude gastric necrosis or perforation.

DOI： 10.1155/2019/1824101

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その他リンク： http://downloads.hindawi.com/journals/cricc/2019/1824101.xml

初療時には診断をつけられなかった農薬中毒の2例

有吉雪乃, 内藤宏道, 竹居セラ, 森本直樹, 三浦雅布, 中尾篤典, 宮石智

中毒研究 32 ( 1 ) 100 - 100 2019年3月

Impact of contrast extravasation on computed tomography of the psoas major muscle in patients with blunt torso trauma 査読国際誌

Tetsuya Yumoto, Hiromichi Naito, Takao Hiraki, Yasuaki Yamakawa, Taihei Yamada, Atsunori Nakao

Journal of Trauma and Acute Care Surgery 86 ( 2 ) 268 - 273 2019年2月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Ovid Technologies (Wolters Kluwer Health)

BACKGROUND: The clinical significance of contrast extravasation (CE) on computed tomography (CT) of the psoas major muscle after blunt torso trauma and the optimal management of patients requiring transcatheter arterial embolization (TAE) of the lumbar artery have not been well elucidated. The aim of this study was to investigate the impact of CE on CT to determine the need for TAE of the lumbar artery. METHODS: We examined a single-center retrospective cohort of blunt torso trauma patients who underwent contrast-enhanced CT from 2008 to 2017. Basic demographics and clinical data were obtained, including the number of lumbar transverse process fractures (LTPFs) and maximum psoas major muscle hematoma (PMMH) size and ratio. Maximum PMMH size was analyzed by measuring the cross-sectional area of hematoma size at the level of CE. Psoas major muscle hematoma size ratio was obtained by dividing maximum PMMH size by psoas major muscle size of the unaffected side at the same slice level. RESULTS: A total of 762 patients were included. One hundred seventeen patients had LTPFs and/or PMMH. Of 117 patients, 25 had CE on CT of the psoas major muscle and had significantly higher rates of older age and severe injury compared with those without CE. Of the 25 patients with CE, 13 required TAE of the lumbar artery. Patients who required TAE had a significantly higher number of LTPFs (4 vs. 2, p = 0.011) and higher PMMH size ratio (2.10 vs. 1.32, p = 0.016). Psoas major muscle hematoma size ratio revealed moderate accuracy (area under the receiver operating characteristic curve, 0.782). CONCLUSIONS: Approximately half of the blunt torso trauma patients with CE on CT of the psoas major muscle will require TAE of the lumbar artery. Higher number of LTPFs and larger PMMH size can be a predictor of the need for TAE of the lumbar artery among patients with CE on CT. LEVEL OF EVIDENCE: Therapeutic/care management, level IV.

DOI： 10.1097/ta.0000000000002121

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Mortality in trauma patients admitted during, before, and after national academic emergency medicine and trauma surgery meeting dates in Japan 査読国際誌

Tetsuya Yumoto, Hiromichi Naito, Hiromi Ihoriya, Takashi Yorifuji, Atsunori Nakao

PLOS ONE 14 ( 1 ) e0207049 - e0207049 2019年1月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Public Library of Science (PLoS)

Annually, many physicians attend national academic meetings. While participating in these meetings can have a positive impact on daily medical practice, attendance may result in reduced medical staffing during the meeting dates. We sought to examine whether there were differences in mortality after trauma among patients admitted to the hospital during, before, and after meeting dates. Using the Japan Trauma Data Bank, we analyzed in-hospital mortality in patients with traumatic injury admitted to the hospital from 2004 to 2015 during the dates of two national academic meetings-the Japanese Association for Acute Medicine (JAAM) and the Japanese Association for the Surgery of Trauma (JAST). We compared the data with that of patients admitted with trauma during identical weekdays in the weeks before and after the meetings, respectively. We used multiple logistic regression analysis to compare outcomes among the three groups. A total of 7,491 patients were included in our analyses, with 2,481, 2,492, and 2,518 patients in the during, before, and after meeting dates groups, respectively; their mortality rates were 7.3%, 8.0%, and 8.5%, respectively. After adjusting for covariates, no significant differences in in-hospital mortality were found among the three groups (adjusted odds ratio [95% CI] of the before meeting dates and after meeting dates groups; 1.18 [0.89-1.56] and 1.23 [0.93-1.63], respectively, with the during meeting dates group as the reference category). No significant differences in in-hospital mortality were found among trauma patients admitted during, before, and after the JAAM and JAST meeting dates.

DOI： 10.1371/journal.pone.0207049

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