Research Interests: Pediatrics and Medicine
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The blood lactate level is used to guide the management of trauma patients with circulatory disturbance. We hypothesized that blood lactate levels at the scene (Lac scene) could improve the prediction for immediate interventions for... more
The blood lactate level is used to guide the management of trauma patients with circulatory disturbance. We hypothesized that blood lactate levels at the scene (Lac scene) could improve the prediction for immediate interventions for hemorrhage. We prospectively measured blood lactate levels and assessed retrospectively in 435 trauma patients both at the scene and on arrival at the emergency room (ER) of a level I trauma center. Primary outcome was immediate intervention for hemorrhage defined as surgical/radiological intervention and/or blood transfusion within 24 h. Physiological variables plus Lac scene significantly increased the predictive value for immediate intervention (area under the curve [AUC] 0.882, 95% confidence interval [CI] 0.839–0.925) compared to that using physiological variables only (AUC 0.837, 95% CI 0.787–0.887, P = 0.0073), replicated in the validation cohort (n = 85). There was no significant improvement in predicting value of physiological variables plus Lac...
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AimSelf‐harm is a common ambulance call and is potentially affected by the COVID‐19 pandemic. The aim of this study was to investigate whether the incidence of ambulance transport due to self‐harm increased in 2020.MethodsWe undertook a... more
AimSelf‐harm is a common ambulance call and is potentially affected by the COVID‐19 pandemic. The aim of this study was to investigate whether the incidence of ambulance transport due to self‐harm increased in 2020.MethodsWe undertook a population‐based observational study using a database from the Osaka prefectural government. Ambulance transport of patients due to self‐harm from 2016 through 2020 was investigated. We estimated adjusted incidence rate ratios using a Poisson regression model to compare the annual incidence rates of ambulance transport in 2017–2020 with those in 2016. We also provided age‐stratified analysis.ResultsWe analyzed 13,648 patients. There was no difference in the incidence of ambulance transport due to self‐harm in 2017, 2018, 2019, and 2020 compared with 2016. In the age group of 20–29 years, despite no difference in 2017–2019 compared with 2016, we found a 13.8% increase in the incidence of ambulance transport due to self‐harm in 2020 (adjusted incidence rate ratio, 1.138; 95% confidence interval, 1.025–1.265).ConclusionsAlthough there was no difference in the incidence of ambulance transport due to self‐harm in 2017–2019, that in 2020 increased in the age group of 20–29 years.
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The emergency medical system, one of the essential elements of public health, has been around for more than 50 years. Although many studies have assessed the factors associated with overcrowding and prolonged length of stay in emergency... more
The emergency medical system, one of the essential elements of public health, has been around for more than 50 years. Although many studies have assessed the factors associated with overcrowding and prolonged length of stay in emergency departments, whether the clinical characteristics and background of a patient are associated with prolonged hospitalization among patients transported by ambulance is unknown. The purpose of this study was to reveal factors associated with the continuation of hospitalization at 21 days after hospital admission among patients transported by ambulance using a population-based patient registry in Osaka, Japan. This was a retrospective observational study whose study period was the three years from January 2016 to December 2018. In this study, we included patients who were hospitalized after transportation by ambulance in Osaka, Japan. The main outcome was continuation of hospitalization at 21 days after hospital admission. We calculated the adjusted odds ratios (AOR) and 95% confidence interval (CI) with a multivariable logistic regression model to assess factors associated with the outcome. We included 481,886 patients in this study, of whom 158,551 remained hospitalized at 21 days after hospital admission and 323,335 had been discharged home by 21 days after hospital admission. Factors associated with prolonged hospitalization were elderly (AOR: 1.767 [95% CI: 1.730–1.805]), traffic accident (AOR: 1.231 [95% CI: 1.183–1.282]), no fixed address (AOR: 4.494 [95% CI: 3.632–5.314]), need for nursing care (AOR: 1.420 [95% CI: 1.397–1.443]) and solitary person (AOR: 1.085 [95% CI: 1.050–1.120]). In this study, the elderly, traffic accidents, no fixed address, need for nursing care, and solitary person were associated with prolonged hospitalization of patients transported by ambulance in Japan.
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Although growth hormone (GH) is a potential agent to counteract the catabolic response to general and head injuries, the complications of GH treatment have been little studied. To evaluate the safety of GH in head trauma patients, it was... more
Although growth hormone (GH) is a potential agent to counteract the catabolic response to general and head injuries, the complications of GH treatment have been little studied. To evaluate the safety of GH in head trauma patients, it was investigated whether GH affects brain oedema caused by brain injury, using a rat freeze-injury model. Male Wistar rats (n = 28) were divided into four groups according to the substance injected (GH vs. saline) and whether brain was injured or not. GH (0.8 IU/kg) or saline was injected subcutaneously every 24 hours. In the injury groups, immediately before the first injection of GH, an aluminum rod cooled to -50 degrees C was placed on the right parietal region for 4 minutes, under anaesthesia. At 96 hours after the insult, brain and skeletal muscle were excised and their water content was measured, by drying. Freeze injury of the brain caused an increase in water content in skeletal muscle. GH injection augmented this oedema in skeletal muscle. Freeze injury of the brain also caused an increase in water content in the injured and non-injured hemispheres of brain and cerebellum. GH administration did not exacerbate brain oedema caused by brain injury in this model.
Research Interests: Traumatic Brain Injury, Skeletal muscle biology, Medicine, Growth Hormone, Internal Medicine, and 14 moreAnimals, Male, Brain injury, Skeletal Muscle, Head injury, Rats, Edema, Saline, Wistar Rats, Brain Edema, Brain Diseases, Brain injuries, Psychology and Cognitive Sciences, and Medical and Health Sciences
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Although the COVID-19 pandemic affects the emergency medical service (EMS) system, little is known about the impact of the COVID-19 pandemic on the prognosis of emergency patients. This study aimed to reveal the impact of the COVID-19... more
Although the COVID-19 pandemic affects the emergency medical service (EMS) system, little is known about the impact of the COVID-19 pandemic on the prognosis of emergency patients. This study aimed to reveal the impact of the COVID-19 pandemic on the EMS system and patient outcomes. We included patients transported by ambulance who were registered in a population-based registry of patients transported by ambulance. The endpoints of this study were the incident number of patients transported by ambulance each month and the number of deaths among these patients admitted to hospital each month. The incidence rate ratio (IRR) and 95% confidence interval (CI) using a Poisson regression model with the year 2019 as the reference were calculated. A total of 500,194 patients were transported in 2019, whereas 443,321 patients were transported in 2020, indicating a significant decrease in the number of emergency patients transported by ambulance (IRR: 0.89, 95% CI: 0.88–0.89). The number of de...
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Background; Novel corona virus (COVID-19) outbreaks have spread worldwide. Although the COVID-19 pandemic affects the emergency medical service (EMS) system, which is one factor of primary care, little is known about its impact. This... more
Background; Novel corona virus (COVID-19) outbreaks have spread worldwide. Although the COVID-19 pandemic affects the emergency medical service (EMS) system, which is one factor of primary care, little is known about its impact. This study aimed to reveal the impact of the COVID-19 pandemic on the EMS system and outcome of patients transported by ambulance.Methods; This was a retrospective study with a study period from 1 January 2020 to 31 May 2020. We included patients transported by ambulance who were registered in a population-based registry of patients transported by ambulance. The endpoints of this study were the incident number of patients transported by ambulance each month and the number of deaths among these patients admitted to hospital each month. We calculated the incidence rate ratio (IRR) and 95% confidence interval (CI) using a Poisson regression model with year 2019 as the reference.Results; From January to May 2019, 205,195 patients were transported, whereas from J...
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AimTo assess the impact of the Summit on Financial Markets and the World Economy held in Osaka City, Japan (G20 Osaka Summit) on the emergency medical services (EMS) system.MethodsThis study used the ORION database with its... more
AimTo assess the impact of the Summit on Financial Markets and the World Economy held in Osaka City, Japan (G20 Osaka Summit) on the emergency medical services (EMS) system.MethodsThis study used the ORION database with its population‐based registry of emergency patients comprising both ambulance and in‐hospital records in Osaka Prefecture, Japan. The G20 Osaka Summit was held in Osaka City from 28 to 29 June, 2019. Changes in the EMS system and traffic regulations in Osaka were made during the period from 27 to 30 June, but we focused on the two summit days as the G20 period. The control periods comprised the same calendar days 1 week before and 1 week after the G20 period. We evaluated differences in the number of emergency transports, difficulties in obtaining hospital acceptance of patients, deaths among hospitalized emergency patients, and ambulance transport times between the two periods.ResultsIn total, 2,590 cases in the G20 period and 5,152 cases in the control periods were...
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Background: Novel corona virus (COVID-19) outbreaks have spread worldwide. Although the COVID-19 pandemic affects the emergency medical service (EMS) system, which is one factor of primary care, little is known about its impact. This... more
Background: Novel corona virus (COVID-19) outbreaks have spread worldwide. Although the COVID-19 pandemic affects the emergency medical service (EMS) system, which is one factor of primary care, little is known about its impact. This study aimed to reveal the impact of the COVID-19 pandemic on the EMS system and outcome of emergency patients transported by ambulance in Osaka Prefecture, Japan. Methods: This was a retrospective study with a study period from 1 January 2020 to 31 May 2020. We included patients transported by ambulance who were registered in a population-based registry of emergency patients transported by ambulance. The primary endpoints of this study were the incident number of patients transported by ambulance each month and the number of deaths among emergency patients admitted to hospital each month. We calculated the incidence rate ratio (IRR) and 95% confidence interval (CI) using a Poisson regression model with year 2019 as the reference. Findings: From January to May 2019, 205,195 patients were transported, whereas from January to May 2020, 180,362 patients were transported, indicating a significant decrease in the number of emergency patients transported by ambulance (IRR: 0.88, 95% CI: 0.87–0.88). The number of deaths among emergency patients admitted to hospital was 5237 in January-May 2019 and remained unchanged at 5172 in January-May 2020 (IRR: 0.99, 95% CI: 0.95–1.03). Interpretation: The first surge of the COVID-19 pandemic had no adverse effect on the EMS system in Osaka Prefecture, Japan. Funding: Japanese Society of the Promotion of Science KAKENHI (grant no. JP18H02902). Declaration of Interests: All authors of this manuscript declared that they have no conflicts of interest that relate to the content of this manuscript. Ethics Approval Statement: This study was approved by the Ethics Committee of Osaka University Graduate School of Medicine (approval no. 15003).
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Hyperfibrinolysis is a critical complication in severe trauma. Hyperfibrinolysis is traditionally diagnosed via elevated D-dimer or fibrin/fibrinogen degradation product levels, and recently, using thromboelastometry. Although... more
Hyperfibrinolysis is a critical complication in severe trauma. Hyperfibrinolysis is traditionally diagnosed via elevated D-dimer or fibrin/fibrinogen degradation product levels, and recently, using thromboelastometry. Although hyperfibrinolysis is observed in patients with severe isolated traumatic brain injury (TBI) on arrival at the emergency department (ED), it is unclear which factors induce hyperfibrinolysis. The present study aimed to investigate the factors associated with hyperfibrinolysis in patients with isolated severe TBI. We conducted a multicentre retrospective review of data for adult trauma patients with an injury severity score ≥ 16, and selected patients with isolated TBI (TBI group) and extra-cranial trauma (non-TBI group). The TBI group included patients with an abbreviated injury score (AIS) for the head ≥ 4 and an extra-cranial AIS < 2. The non-TBI group included patients with an extra-cranial AIS ≥ 3 and head AIS < 2. Hyperfibrinolysis was defined as a D...
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In the early phase of trauma, fibrinogen (Fbg) plays an important role in clot formation. However, to the best of our knowledge, few studies have analysed methods of predicting the need for massive transfusion (MT) based on Fbg levels... more
In the early phase of trauma, fibrinogen (Fbg) plays an important role in clot formation. However, to the best of our knowledge, few studies have analysed methods of predicting the need for massive transfusion (MT) based on Fbg levels using multiple logistic regression. Therefore, the present study aimed to evaluate whether Fbg levels on admission can be used to predict the need for MT in patients with trauma. We conducted a retrospective multicentre observational study. Patients with blunt trauma with ISS ≥16 who were admitted to 15 tertiary emergency and critical care centres in Japan participating in the J-OCTET were enrolled in the present study. MT was defined as the transfusion of packed red blood cells (PRBC) ≥10 units or death caused by bleeding within 24h after admission. Patients were divided into non-MT and MT groups. Multiple logistic-regression analysis was used to assess the predictive value of the variables age, sex, vital signs, Glasgow Coma Scale (GCS) score, and Fb...
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Key Clinical MessageWe report the rare case of delayed hemothorax (DHX) with an inferior phrenic artery (IPA) injury due to blunt thoracic trauma. Our case suggests that DHX almost always occurs early after injury, and endovascular... more
Key Clinical MessageWe report the rare case of delayed hemothorax (DHX) with an inferior phrenic artery (IPA) injury due to blunt thoracic trauma. Our case suggests that DHX almost always occurs early after injury, and endovascular treatment is an effective procedure for traumatic hemothorax including DHX.
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This study was undertaken to define the factors that affected the final outcome of trauma patients in the Hanshin-Awaji earthquake. Medical records of patients admitted to 95 hospitals within or surrounding the affected area during the... more
This study was undertaken to define the factors that affected the final outcome of trauma patients in the Hanshin-Awaji earthquake. Medical records of patients admitted to 95 hospitals within or surrounding the affected area during the first 15 days after the quake were reviewed. There were 2,702 traumatized patients. One-third of the patients were transported to hospitals in the surrounding area and had a mortality rate of 3%. The remainder, who were treated in the affected hospitals, showed a significantly higher mortality rate (8%; p &lt; 0.05). Intensive care was provided for 513 patients, most of whom suffered from crush syndrome or from injuries to vital organs; these patients had a high mortality rate. Patients with other types of injuries had a lower mortality rate. Crush syndrome and injuries to vital organs were potentially life-threatening. We believe that early transportation of such patients to undamaged hospitals with the ability to provide intensive care would have improved the survival rate.
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Liver abscess remains a life-threatening disease, particularly when it results in systemic organ failure necessitating intensive care. Only few cases of respiratory failure caused by liver abscess and treated with veno-venous... more
Liver abscess remains a life-threatening disease, particularly when it results in systemic organ failure necessitating intensive care. Only few cases of respiratory failure caused by liver abscess and treated with veno-venous extracorporeal membrane oxygenation (ECMO) have been reported. Here we present a case of liver abscess with rapid progression of multiple organ dysfunction, including severe acute respiratory failure on admission to the intensive care unit (ICU). Upon admission, we immediately initiated artificial organ support systems, including ventilator, continuous renal replacement therapy, and cardiovascular drug infusion for septic multiple organ failure and source control. Despite this initial management, respiratory failure deteriorated and V-V ECMO was introduced. The case developed abdominal compartment syndrome, for which we performed a bedside decompressive laparotomy in the ICU. The case gradually recovered from multiple organ failure and was discharged from the I...
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Research Interests: Emergency Medicine, Communication, Disaster Response, Japan, Intelligent Transport System, and 15 moreMedicine, Disasters, Humans, INTENSIVE CARE, Female, Male, Clinical Sciences, Medical Emergency, Backup, Medical Records, Medical Record, Medical Audit, Ministry of Health, Crush Syndrome, and Emergency medical service
Research Interests: Endocrinology, Treatment Outcome, Medicine, Humans, Internal Medicine, and 13 moreInsulin, Diabetes mellitus, Male, Clinical Sciences, Adult, Public health systems and services research, Phosphates, Type 2 Diabetes Mellitus, Diabetic ketoacidosis, Hypophosphatemia, Hypertriglyceridemia, Metabolic Syndrome X, and Heart arrest
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To demonstrate the clinical characteristics of patients with cervical cord injury (CCI) without bony injury in Japan. Retrospective review of 127 patients with CCI without bony injury treated between January 2003 and October 2005 at 11... more
To demonstrate the clinical characteristics of patients with cervical cord injury (CCI) without bony injury in Japan. Retrospective review of 127 patients with CCI without bony injury treated between January 2003 and October 2005 at 11 institutions. Prevalence of CCI without bony injury was 32.2% among all CCIs and 0.81% among all blunt traumas. Mean age was 60.4 years (range, 19-90 years), with 104 patients (82%) &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 46 years old (older group). The major mechanism of injury among younger patients (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 46 years) was traffic injuries (39%), whereas minor falls (44%) predominated in older patients. High-energy mechanisms of injury were significantly more common for younger patients (35% versus 15%, p = 0.041). Mean injury severity score, abbreviated injury score for the head and Glasgow coma scale on admission were 17.2 +/- 4.7, 0.6 +/- 0.9, and 14.2 +/- 2.1, respectively. Incomplete CCI occurred in 88.7%. On plain cervical spine radiography, spinal canal stenosis and spondylosis or ossification of the posterior longitudinal ligament were more frequent in older patients than in younger patients (43% vs. 13%, p = 0.008; 54% vs. 17%, p = 0.002, respectively). No abnormal findings were seen in 52% of younger patients. CCI without bony injury occurred more frequently in this study population than previously reported. Degenerative changes and spinal canal stenosis represent important risk factors for developing CCI without bony injury and the present results suggest that this injury may occur in younger adults during high-energy injuries in the absence of pre-existing cervical spine disease.
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We have been developing the CAD scheme for head and abdominal injuries for emergency medical care. In this work, we have developed an automated method to detect typical head injuries, rupture or strokes of brain. Extradural and subdural... more
We have been developing the CAD scheme for head and abdominal injuries for emergency medical care. In this work, we have developed an automated method to detect typical head injuries, rupture or strokes of brain. Extradural and subdural hematoma region were detected by comparing technique after the brain areas were registered using warping. We employ 5 normal and 15 stroke
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ObjectiveThis study aimed to provide a classification system for acute pancreatitis by applying the principle that the disease spreads along the retroperitoneal interfascial planes.
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In the 1995 Hanshin-Awaji earthquake, 504 deaths were listed as fire related, although many of the victims may have been crushed or suffocated before they were burned. Census data related to surviving burn victims, however, were unknown.... more
In the 1995 Hanshin-Awaji earthquake, 504 deaths were listed as fire related, although many of the victims may have been crushed or suffocated before they were burned. Census data related to surviving burn victims, however, were unknown. This study was designed to examine the medical requirements of those burn patients following the earthquake. Medical records of 2718 patients with injuries
Research Interests: Ergonomics, Human Factors, Injury Prevention, Japan, Safety, and 16 moreEmergency Medical Services, Disasters, Humans, INTENSIVE CARE, Medical Care, Clinical Sciences, Burns, Surface Area, Survival Rate, Retrospective Studies, Occupational Safety, Urban Population, Soft Tissue, Medical Records, Hospital Mortality, and Environmental Exposure
Because of the known sodium and water retention associated with growth hormone (GH) therapy, it is crucial to evaluate the safety of GH after brain injury. To clarify this issue, we investigated whether GH affects brain edema in a rat... more
Because of the known sodium and water retention associated with growth hormone (GH) therapy, it is crucial to evaluate the safety of GH after brain injury. To clarify this issue, we investigated whether GH affects brain edema in a rat brain freeze-injury model. Male Wistar rats (n = 29) were divided into four groups according to the substance injected (GH vs. normal saline) and whether the brain was injured or not. The subcutaneous injections of GH (0.8 IU/kg) or saline were given 24 hours apart. In the injury groups, after the second injection, an aluminum rod (4-mm diameter) cooled to -50 degrees C was placed on the exposed dura mater in the right parietal region for 4 minutes, under anesthesia. At 4 hours after the insult, brain and skeletal muscle were excised and their water content was measured by drying. Freeze injury of the brain caused an increase in water and sodium content in skeletal muscle. GH injection augmented this edema in skeletal muscle. Freeze injury of the brain...