地方の基幹病院における高エネルギー外傷の治療成績と問題点

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  • Current problems in the emergency hospital of Japanese rural city from the aspect of treating high-energy trauma

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<p>Objectives: In recent years, traumatic care in Japan was ad­vanced as standardized methodology was adopted in many hos­pitals including rural regions, where our hospital (Kumamoto Rosai Hospital) was not exception. To improve traumatic care, we adopted Japan advanced trauma evaluation and care (JATEC) as a standard following national guidelines. However, honest reports with respect to traumatic care actually being implemented in rural hospital was still rare, so that it was very much expected to highlight the true nature of traumatic care in Japan. We report the review of 263 cases treated as high-energy trauma that our hospital experienced from January 2009 to August 2010.</p><p>Results: We categorized those traumatic cases according to affected body parts, severity, and clinical outcomes. We especially focused on the evaluation of the dead cases and multiple injuries based upon abbreviated injury score (AIS) by calculating probability of survival (Ps) yielded by trauma and injury severity score (TRISS). The dead cases were consisted of 8% (21 cases) of total. The result showed there were only five cases that we considered as unexpected deaths with Ps over 0.5, among which four cases were regarded as preventable trauma death (PTD). The number of PTD among treated death cases (15 cases) consisted of 26.7%, which was still higher than recent average in Japan. Peer review attributed the four PTD cases to severe bleeding after whole body CT as secondary survey and enlargement of subdural hematoma after other department than neurosurgery. Evaluation of 21 cases with multiple traumas demonstrated high mortality rate of 61.9% (13 cases), the majority of those had composition of severe head injury, hemopneumothorax and/or pulmonary contusion, and pelvic fracture.</p><p>Conclusion: Shortage of manpower and lack of intensive-care setting which imposed upon rural hospital very much like ours may be responsible for this results. However, further improvement of co-operation between different department as well as professional training for trauma care might overcome those shortcomings.</p>

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  • 神経外傷

    神経外傷 34 (1), 26-32, 2011-12-27

    一般社団法人 日本脳神経外傷学会

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