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Association between the Japan Coma Scale scores at the scene of injury and in-hospital outcomes in trauma patients: an analysis from the nationwide trauma database in Japan.

Abstract：

OBJECTIVE:Japan Coma Scale (JCS) is a grading system used to evaluate disturbed consciousness in prehospital care settings. We aimed to identify the association between the JCS levels at the scene with in-hospital mortality, as well as the discrimination ability for the outcomes. DESIGN:A retrospective cohort study based on the nationwide trauma database in Japan. SETTING:Multicentre cohort study using data from the Japan Trauma Data Bank, which is a nationwide, prospective, observational trauma registry derived from 235 hospitals. PARTICIPANTS:Adult trauma victims transferred directly from the scene of injury to the hospital from January 2004 to December 2017 were eligible for inclusion. PRIMARY AND SECONDARY OUTCOMES:Primary outcome was the association between the JCS levels at the scene with in-hospital mortality. We conducted a multivariate logistic regression analysis to calculate the adjusted ORs of JCS levels with 95% CIs for in-hospital mortality. We also calculated the c-statistics for in-hospital mortality. RESULTS:164 723 patients were included in the analysis. In a multivariate logistic regression analysis, the corresponding adjusted ORs of JCS levels 2 and 3 referred to level 1 for in-hospital mortality were 4.1 (95% CI 3.8 to 4.4) and 26.0 (95% CI 24.8 to 27.2). The c-statistics of the JCS level for in-hospital mortality was 0.845 (95% CI 0.842 to 0.849). CONCLUSIONS:Data from large multicentre prospective registry revealed strong associations of the JCS level at the scene of injury with in-hospital mortality as well as the good discriminatory performance for this outcome.

journal_name

BMJ Open

journal_title

BMJ open

authors

Okada Y,Kiguchi T,Iiduka R,Ishii W,Iwami T,Koike K

doi

10.1136/bmjopen-2019-029706

subject

Has Abstract

pub_date

2019-07-30 00:00:00

pages

e029706

issue

7

issn

2044-6055

pii

bmjopen-2019-029706

journal_volume

9

pub_type

杂志文章,多中心研究

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