Recent trends in 30-day mortality in patients with blunt splenic injury: A nationwide trauma database study in Japan.
BACKGROUND:Splenic injury frequently occurs after blunt abdominal trauma; however, limited epidemiological data regarding mortality are available. We aimed to investigate mortality rate trends after blunt splenic injury in Japan. METHODS:We retrospectively identified 1,721 adults with blunt splenic...
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2017-01-01
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| Series: | PLoS ONE |
| Online Access: | http://europepmc.org/articles/PMC5599007?pdf=render |
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| author | Chie Tanaka Takashi Tagami Hisashi Matsumoto Kiyoshi Matsuda Shiei Kim Yuta Moroe Reo Fukuda Kyoko Unemoto Hiroyuki Yokota |
| author_facet | Chie Tanaka Takashi Tagami Hisashi Matsumoto Kiyoshi Matsuda Shiei Kim Yuta Moroe Reo Fukuda Kyoko Unemoto Hiroyuki Yokota |
| author_sort | Chie Tanaka |
| collection | DOAJ |
| description | BACKGROUND:Splenic injury frequently occurs after blunt abdominal trauma; however, limited epidemiological data regarding mortality are available. We aimed to investigate mortality rate trends after blunt splenic injury in Japan. METHODS:We retrospectively identified 1,721 adults with blunt splenic injury (American Association for the Surgery of Trauma splenic injury scale grades III-V) from the 2004-2014 Japan Trauma Data Bank. We grouped the records of these patients into 3 time phases: phase I (2004-2008), phase II (2009-2012), and phase III (2013-2014). Over the 3 phases, we analysed 30-day mortality rates and investigated their association with the prevalence of certain initial interventions (Mantel-Haenszel trend test). We further performed multiple imputation and multivariable analyses for comparing the characteristics and outcomes of patients who underwent TAE or splenectomy/splenorrhaphy, adjusting for known potential confounders and for within-hospital clustering using generalised estimating equation. RESULTS:Over time, there was a significant decrease in 30-day mortality after splenic injury (p < 0.01). Logistic regression analysis revealed that mortality significantly decreased over time (from phase I to phase II, odds ratio: 0.39, 95% confidence interval: 0.22-0.67; from phase I to phase III, odds ratio: 0.34, 95% confidence interval: 0.19-0.62) for the overall cohort. While the 30-day mortality for splenectomy/splenorrhaphy diminished significantly over time (p = 0.01), there were no significant differences regarding mortality for non-operative management, with or without transcatheter arterial embolisation (p = 0.43, p = 0.29, respectively). CONCLUSIONS:In Japan, in-hospital 30-day mortality rates decreased significantly after splenic injury between 2004 and 2014, even after adjustment for within-hospital clustering and other factors independently associated with mortality. Over time, mortality rates decreased significantly after splenectomy/splenorrhaphy, but not after non-operative management. This information is useful for clinicians when making decisions about treatments for patients with blunt splenic injury. |
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| id | doaj.art-d4ea0ae5c32d41d492f4ed385eb4c7df |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-22T17:40:43Z |
| publishDate | 2017-01-01 |
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| spelling | doaj.art-d4ea0ae5c32d41d492f4ed385eb4c7df2022-12-21T18:18:25ZengPublic Library of Science (PLoS)PLoS ONE1932-62032017-01-01129e018469010.1371/journal.pone.0184690Recent trends in 30-day mortality in patients with blunt splenic injury: A nationwide trauma database study in Japan.Chie TanakaTakashi TagamiHisashi MatsumotoKiyoshi MatsudaShiei KimYuta MoroeReo FukudaKyoko UnemotoHiroyuki YokotaBACKGROUND:Splenic injury frequently occurs after blunt abdominal trauma; however, limited epidemiological data regarding mortality are available. We aimed to investigate mortality rate trends after blunt splenic injury in Japan. METHODS:We retrospectively identified 1,721 adults with blunt splenic injury (American Association for the Surgery of Trauma splenic injury scale grades III-V) from the 2004-2014 Japan Trauma Data Bank. We grouped the records of these patients into 3 time phases: phase I (2004-2008), phase II (2009-2012), and phase III (2013-2014). Over the 3 phases, we analysed 30-day mortality rates and investigated their association with the prevalence of certain initial interventions (Mantel-Haenszel trend test). We further performed multiple imputation and multivariable analyses for comparing the characteristics and outcomes of patients who underwent TAE or splenectomy/splenorrhaphy, adjusting for known potential confounders and for within-hospital clustering using generalised estimating equation. RESULTS:Over time, there was a significant decrease in 30-day mortality after splenic injury (p < 0.01). Logistic regression analysis revealed that mortality significantly decreased over time (from phase I to phase II, odds ratio: 0.39, 95% confidence interval: 0.22-0.67; from phase I to phase III, odds ratio: 0.34, 95% confidence interval: 0.19-0.62) for the overall cohort. While the 30-day mortality for splenectomy/splenorrhaphy diminished significantly over time (p = 0.01), there were no significant differences regarding mortality for non-operative management, with or without transcatheter arterial embolisation (p = 0.43, p = 0.29, respectively). CONCLUSIONS:In Japan, in-hospital 30-day mortality rates decreased significantly after splenic injury between 2004 and 2014, even after adjustment for within-hospital clustering and other factors independently associated with mortality. Over time, mortality rates decreased significantly after splenectomy/splenorrhaphy, but not after non-operative management. This information is useful for clinicians when making decisions about treatments for patients with blunt splenic injury.http://europepmc.org/articles/PMC5599007?pdf=render |
| spellingShingle | Chie Tanaka Takashi Tagami Hisashi Matsumoto Kiyoshi Matsuda Shiei Kim Yuta Moroe Reo Fukuda Kyoko Unemoto Hiroyuki Yokota Recent trends in 30-day mortality in patients with blunt splenic injury: A nationwide trauma database study in Japan. PLoS ONE |
| title | Recent trends in 30-day mortality in patients with blunt splenic injury: A nationwide trauma database study in Japan. |
| title_full | Recent trends in 30-day mortality in patients with blunt splenic injury: A nationwide trauma database study in Japan. |
| title_fullStr | Recent trends in 30-day mortality in patients with blunt splenic injury: A nationwide trauma database study in Japan. |
| title_full_unstemmed | Recent trends in 30-day mortality in patients with blunt splenic injury: A nationwide trauma database study in Japan. |
| title_short | Recent trends in 30-day mortality in patients with blunt splenic injury: A nationwide trauma database study in Japan. |
| title_sort | recent trends in 30 day mortality in patients with blunt splenic injury a nationwide trauma database study in japan |
| url | http://europepmc.org/articles/PMC5599007?pdf=render |
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