title: In-hospital trauma mortality has decreased in Japan possibly due to trauma education.
abstract: BACKGROUND
  The Japan Advanced Trauma Evaluation and Care (JATEC) education program was introduced in 2002. To examine its effect on the survival of trauma patients, we investigated changes in trauma mortality in Japan in the years after JATEC was introduced.
  
  
  METHODS
  We included patients registered in the Japan Trauma Databank (JTDB) from 2004 to 2011 with clear in-hospital mortality and sufficient data to estimate the Trauma Injury Severity Score (TRISS). Patients were grouped into the early (2004-2006), transition (2007-2008), and late (2009-2011) cohorts. We performed logistic regression analyses after adjusting for TRISS to estimate risk of death in the transition and late cohorts compared with the early cohort. Stratified logistic regression analyses showed which characteristics contributed to the changes in mortality.
  
  
  RESULTS
  Of 94,664 patients registered in the JTDB, 47,095 were selected. Adjusted mortality was significantly lower in the late cohort (odds ratio = 0.68; 95% CI, 0.61-0.76) than in the early cohort (reference). Stratification analyses demonstrated significant interactions in patients with or without any chest or abdominal surgery (odds ratio = 0.83 vs 0.68; p < 0.001 in the late cohort) and in patients with TRISS probability of survival <0.5 or ≥ 0.5 (odds ratio = 0.71 vs 0.67 for TRISS probability of survival ≥ 0.5; p < 0.001 in the late cohort).
  
  
  CONCLUSIONS
  Since 2007, mortality has decreased in patients with mild trauma injury; however, mortality was significantly worse for severely injured patients or patients requiring surgical procedures. These findings suggest that definitive trauma care in Japan should be strengthened.
authors.affiliation: Medical Hospital of Tokyo Medical and Dental University, Shock, Trauma and Emergency Medical Center, Tokyo.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Hondo
authors.forename: Atsushi
authors.initials: A
authors.lastname: Shiraishi
authors.forename: Satoshi
authors.initials: S
authors.lastname: Fujie
authors.forename: Daizoh
authors.initials: D
authors.lastname: Saitoh
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Otomo
mesh_terms: D000328:Adult; D000368:Aged; D004638:Emergency Treatment; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D007564:Japan; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D014194:Traumatology / Q000193:education; D014947:Wounds and Injuries / Q000401:mortality*
keywords: AIS; ATOM; Abbreviated Injury Scale; Advanced Trauma Operative Management; ED; ISS; Injury Severity Score; JATEC; JTDB; Japan Advanced Trauma Evaluation and Care; Japan Trauma Databank; OR; TRISS; Trauma Injury Severity Score; emergency department; odds ratio