Trends in isolated chest trauma in Japan: a 15-year analysis using the Japan Trauma Data Bank

There were no nationwide studies that comprehensively included all types of isolated chest trauma, which makes it difficult for us to get a complete picture of patients with isolated chest trauma. To overcome this, we conducted a survey of isolated chest trauma using data from the Japan Trauma Data Bank (JTDB).

Between January 2004 and May 2019, a total of 361,706 trauma cases were recorded in the JTDB. From this cohort, 9,475 patients (2.6%) presenting with isolated chest trauma were identified. These patients were categorized into three cohorts based on the year of registration (2004-2008: n=981; 2009-2013: n=3,338; 2014-2019: n=5,156), and temporal trends in clinical characteristics were evaluated. Subsequently, we compared clinical profiles between patients discharged alive (n=8,266) and those who died during hospitalization (n=1,209). Lastly, we conducted an analysis to determine factors associated with in-hospital mortality.

The overall in-hospital mortality rate among all patients was 12.8%. A significant decline in mortality was observed throughout the study period (P<0.001). Multivariate analysis identified older age [odds ratio (OR): 1.03; 95% confidence interval (CI): 1.020-1.040; P<0.001] and fall-related trauma (OR: 2.510; 95% CI: 1.300-4.860; P=0.006) as independent predictors of in-hospital death. Conversely, injuries involving the lung (OR: 0.464; 95% CI: 0.309-0.697; P<0.001), pericardium (OR: 0.305; 95% CI: 0.120-0.773; P=0.01), and rib cage (OR: 0.417; 95% CI: 0.269-0.648; P<0.001) were significantly associated with improved survival outcomes.

This study demonstrated a temporal decline in in-hospital mortality among patients with isolated chest trauma in Japan, suggesting advancements in the management of such injuries. Furthermore, trauma involving the lung, pericardium, or rib cage was associated with more favorable clinical outcomes in this population.