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Article: An Analysis of Stress Concerning Pediatric Emergency Care Nurses.

Toida, Chiaki / Morimura, Naoto

2022 Volume 14, Issue 1, Page(s) e21299

Abstract: Objective The aim of this study was an exploratory evaluation of the association between the stressors and stress levels of nurses offering care to critically ill pediatric patients based on their clinical experience and working department in a ... ...

Abstract	Objective The aim of this study was an exploratory evaluation of the association between the stressors and stress levels of nurses offering care to critically ill pediatric patients based on their clinical experience and working department in a university hospital. Methods The data were collected in October 2018 by administering a self-reporting questionnaire to 169 nurses. The initial analysis compared the anxiety levels between the nurse groups based on their workspace. The next analysis estimated the correlation between the total nursing care and stress levels related to caring for critically ill pediatric patients. We assessed the stress level using the visual analog scale (VAS) score and the total duration of working in the hospital, emergency department (ED), and pediatric department among the three nurse groups. Results Overall, 149 (88%) nurses responded to our survey. More nurses from the ED group completed the Advanced Life Support course (19% vs. 3% vs. 7%, p=0.032), and the total VAS scores of the ED group were significantly higher than those of the other groups (median: 80 vs. 56 vs. 54, p=0.005). In the ED group, the total VAS scores negatively correlated with the total duration of working in the hospital (r=-0.292, p=0.022), ED (r=-0.266, p=0.037), and pediatric department (r=-0.505, p<0.001). In the pediatric ward group, the total VAS scores negatively correlated with the total duration of working in the hospital(r=-0.322, p=0.014) and pediatric department (r=-0.375, p=0.004). In the ED group, the proportion of patients who had high anxiety levels with a short duration of working in the pediatric department was significantly higher than that of patients with a long duration of working in the pediatric department (51% vs. 11%, p=0.028). Conclusions The ED nurses, especially those with less clinical experience in pediatric care, felt anxious about pediatric emergency care more strongly than those in the other groups, regardless of age and disease. Establishing a pediatric medical care set and conducting off-the-job training might contribute to reducing anxiety related to pediatric emergency care.
Language	English
Publishing date	2022-01-16
Publishing country	United States
Document type	Journal Article
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.21299
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Incidence, demographics and outcomes of patients with penetrating injury: a Japanese nationwide 10-year retrospective study.

Nagao, Tsuyoshi / Toida, Chiaki / Morimura, Naoto

BMJ open

2023 Volume 13, Issue 10, Page(s) e071873

Abstract: Background: Unintentional injury remains the leading cause of death among Japanese people younger than 35 years; however, data are limited on the evaluation of characteristics, long-term mortality trend and mortality risk of patients with penetrating ... ...

Abstract	Background: Unintentional injury remains the leading cause of death among Japanese people younger than 35 years; however, data are limited on the evaluation of characteristics, long-term mortality trend and mortality risk of patients with penetrating injury in Japan. This prevents the development of effective strategies for trauma care in patients with penetrating injury. Methods: This retrospective cohort study investigated 313 643 patients registered in the Japan Trauma Data Bank (JTDB) dataset between 1 January 2009 and 31 March 2018. The inclusion criteria comprised patients with penetrating injuries transferred from the injury site by emergency vehicles. Moreover, the patients registered in the JTDB dataset were included in this study regardless of age and sex. Outcomes measured were nationwide trends of characteristics, in-hospital mortality and in-hospital mortality risk among Japanese patients with penetrating injury. The mortality risk was analysed by hospital admission year, age, Injury Severity Score (ISS) and emergency procedures. Results: Overall, 7132 patients were included. Median age significantly increased during the 10-year study periods (from 48 to 54 years, p=0.002). Trends for the mechanism of injury did not change; the leading cause of penetrating injury was stab wounds (SW: 76%-82%). Overall, the in-hospital mortality rate significantly decreased (4.0% to 1.7%, p=0.008). However, no significant improvement was observed in the in-hospital mortality trend in all ISS groups with SW and active bleeding. Patients with active bleeding who underwent urgent transcatheter arterial embolization had significantly lower mortality risk (p=0.043, OR=0.12, 95% CI=0.017 to 0.936). Conversely, the surgical procedure for haemostasis did not improve the mortality risk of patients with SW and active bleeding. Conclusion: The severity-adjusted mortality trend in patients with penetrating injuries did not improve. Moreover, patients with active bleeding who underwent urgent surgical procedure for haemostasis had a higher mortality risk.
MeSH term(s)	Humans ; East Asian People ; Incidence ; Injury Severity Score ; Retrospective Studies ; Wounds, Penetrating/epidemiology ; Wounds, Penetrating/surgery ; Wounds, Stab/epidemiology ; Middle Aged ; Japan/epidemiology
Language	English
Publishing date	2023-10-28
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2023-071873
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Article ; Online: Incidence, demographics and outcomes of patients with penetrating injury

Tsuyoshi Nagao / Naoto Morimura / Chiaki Toida

BMJ Open, Vol 13, Iss

a Japanese nationwide 10-year retrospective study

2023 Volume 10

Abstract: Background Unintentional injury remains the leading cause of death among Japanese people younger than 35 years; however, data are limited on the evaluation of characteristics, long-term mortality trend and mortality risk of patients with penetrating ... ...

Abstract	Background Unintentional injury remains the leading cause of death among Japanese people younger than 35 years; however, data are limited on the evaluation of characteristics, long-term mortality trend and mortality risk of patients with penetrating injury in Japan. This prevents the development of effective strategies for trauma care in patients with penetrating injury.Methods This retrospective cohort study investigated 313 643 patients registered in the Japan Trauma Data Bank (JTDB) dataset between 1 January 2009 and 31 March 2018. The inclusion criteria comprised patients with penetrating injuries transferred from the injury site by emergency vehicles. Moreover, the patients registered in the JTDB dataset were included in this study regardless of age and sex. Outcomes measured were nationwide trends of characteristics, in-hospital mortality and in-hospital mortality risk among Japanese patients with penetrating injury. The mortality risk was analysed by hospital admission year, age, Injury Severity Score (ISS) and emergency procedures.Results Overall, 7132 patients were included. Median age significantly increased during the 10-year study periods (from 48 to 54 years, p=0.002). Trends for the mechanism of injury did not change; the leading cause of penetrating injury was stab wounds (SW: 76%–82%). Overall, the in-hospital mortality rate significantly decreased (4.0% to 1.7%, p=0.008). However, no significant improvement was observed in the in-hospital mortality trend in all ISS groups with SW and active bleeding. Patients with active bleeding who underwent urgent transcatheter arterial embolization had significantly lower mortality risk (p=0.043, OR=0.12, 95% CI=0.017 to 0.936). Conversely, the surgical procedure for haemostasis did not improve the mortality risk of patients with SW and active bleeding.Conclusion The severity-adjusted mortality trend in patients with penetrating injuries did not improve. Moreover, patients with active bleeding who underwent urgent surgical procedure for haemostasis had a ...
Keywords	Medicine ; R
Subject code	610 ; 310
Language	English
Publishing date	2023-10-01T00:00:00Z
Publisher	BMJ Publishing Group
Document type	Article ; Online
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Article ; Online: Prehospital medical equipment for care of pediatric injury patients in Japanese ambulances: a nationwide survey.

Toida, Chiaki / Muguruma, Takashi

Acute medicine & surgery

2020 Volume 7, Issue 1, Page(s) e605

Abstract: Aim: We evaluated the status of the allocation of medical emergency equipment suitable for pediatric patients of all ages.: Methods: In 2019, we surveyed the emergency medical officers from 728 fire defense headquarters around Japan. The ... ...

Abstract	Aim: We evaluated the status of the allocation of medical emergency equipment suitable for pediatric patients of all ages. Methods: In 2019, we surveyed the emergency medical officers from 728 fire defense headquarters around Japan. The questionnaire was designed to evaluate the kind and size of equipment available to ambulance crews for prehospital emergency care of injured pediatric patients. A complete pediatric equipment set was defined as a set containing equipment suitable for children aged 0-14 years. Results: Overall, 599 (82%) fire defense headquarters responded to our survey. Of these, 596 (99.5%) declared that pediatric equipment was available to ambulance crews. The allocation rates of complete pediatric sets were considerably low: blood pressure cuff, 5%; nasopharyngeal airway, 1%; oropharyngeal airway, 7%; laryngoscope, 6%; supraglottic airway device, 13%; endotracheal tube, 0.2%; and bag-valve-mask, 23%. Moreover, none of these fire defense headquarters had complete pediatric equipment sets for all 14 devices assessed in this study. Conclusions: Although most Japanese ambulances can provide prehospital emergency care to pediatric patients, this survey revealed the dispersion and deficiencies in the availability of complete pediatric equipment sets.
Language	English
Publishing date	2020-12-21
Publishing country	United States
Document type	Journal Article
ZDB-ID	2751184-4
ISSN	2052-8817 ; 2052-8817
ISSN (online)	2052-8817
ISSN	2052-8817
DOI	10.1002/ams2.605
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Article ; Online: Evaluating the definition of severely injured patients: a Japanese nationwide 5-year retrospective study.

Toida, Chiaki / Muguruma, Takashi / Gakumazawa, Masayasu / Shinohara, Mafumi / Abe, Takeru / Takeuchi, Ichiro

BMJ open

2023 Volume 13, Issue 2, Page(s) e062619

Abstract: Objectives: The definition of severely injured patients lacks universal consensus based on quantitative measures. The most widely used definition of severe injury is based on the Injury Severity Score (ISS), which is calculated using the Abbreviated ... ...

Abstract	Objectives: The definition of severely injured patients lacks universal consensus based on quantitative measures. The most widely used definition of severe injury is based on the Injury Severity Score (ISS), which is calculated using the Abbreviated Injury Scale in Japan. This study aimed to compare the prevalence, in-hospital mortality and OR for mortality in patients with ISS ≥16, ISS ≥18 and ISS ≥26 by age groups. Design: Retrospective cohort study. Setting: Japan Trauma Data Bank, which is a nationwide trauma registry with data from 280 hospitals. Participants: We used data of 117 199 injured patients from a national database. We included injured patients who were transferred from the scene of injury by ambulance and/or physician. Primary and secondary outcome measures: Prevalence, in-hospital mortality and OR for mortality with respect to age and injury level (ISS group). Results: In all age categories, the in-hospital mortality of patient groups with an ISS ≥16, ISS ≥18 and ISS ≥26 was 13.3%, 17.4% and 23.5%, respectively. The in-hospital mortality for patients aged >75 years was the highest (20% greater than that of the other age groups). Moreover, in-hospital mortality for age group 5-14 years was the lowest (4.0-10.9%). In all the age groups, the OR for mortality for patients with ISS ≥16, ISS ≥18 and ISS ≥26 was 12.8, 11.0 and 8.4, respectively. Conclusions: Our results revealed the lack of an acceptable definition, with a high in-hospital mortality and high OR for mortality for all age groups.
MeSH term(s)	Humans ; Retrospective Studies ; East Asian People ; Injury Severity Score ; Abbreviated Injury Scale ; Ambulances ; Hospital Mortality ; Registries ; Trauma Centers ; Wounds and Injuries
Language	English
Publishing date	2023-02-23
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2022-062619
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Article: Validation of the Conventional Trauma and Injury Severity Score and a Newly Developed Survival Predictive Model in Pediatric Patients with Blunt Trauma: A Nationwide Observation Study.

Toida, Chiaki / Muguruma, Takashi / Gakumazawa, Masayasu / Shinohara, Mafumi / Abe, Takeru / Takeuchi, Ichiro

Children (Basel, Switzerland)

2023 Volume 10, Issue 9

Abstract: To date, there is no clinically useful prediction model that is suitable for Japanese pediatric trauma patients. Herein, this study aimed to developed a model for predicting the survival of Japanese pediatric patients with blunt trauma and compare its ... ...

Abstract	To date, there is no clinically useful prediction model that is suitable for Japanese pediatric trauma patients. Herein, this study aimed to developed a model for predicting the survival of Japanese pediatric patients with blunt trauma and compare its validity with that of the conventional TRISS model. Patients registered in the Japan Trauma Data Bank were grouped into a derivation cohort (2009-2013) and validation cohort (2014-2018). Logistic regression analysis was performed using the derivation dataset to establish prediction models using age, injury severity, and physiology. The validity of the modified model was evaluated by the area under the receiver operating characteristic curve (AUC). Among 11 predictor models, Model 1 and Model 11 had the best performance (AUC = 0.980). The AUC of all models was lower in patients with survival probability Ps < 0.5 than in patients with Ps ≥ 0.5. The AUC of all models was lower in neonates/infants than in other age categories. Model 11 also had the best performance (AUC = 0.762 and 0.909, respectively) in patients with Ps < 0.5 and neonates/infants. The predictive ability of the newly modified models was not superior to that of the current TRISS model. Our results may be useful to develop a highly accurate prediction model based on the new predictive variables and cutoff values associated with the survival mortality of injured Japanese pediatric patients who are younger and more severely injured by using a nationwide dataset with fewer missing data and added valuables, which can be used to evaluate the age-related physiological and anatomical severity of injured patients.
Language	English
Publishing date	2023-09-12
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2732685-8
ISSN	2227-9067
ISSN	2227-9067
DOI	10.3390/children10091542
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Article ; Online: Evaluating the definition of severely injured patients

Takashi Muguruma / Ichiro Takeuchi / Takeru Abe / Chiaki Toida / Masayasu Gakumazawa / Mafumi Shinohara

BMJ Open, Vol 13, Iss

a Japanese nationwide 5-year retrospective study

2023 Volume 2

Abstract: Objectives The definition of severely injured patients lacks universal consensus based on quantitative measures. The most widely used definition of severe injury is based on the Injury Severity Score (ISS), which is calculated using the Abbreviated ... ...

Abstract	Objectives The definition of severely injured patients lacks universal consensus based on quantitative measures. The most widely used definition of severe injury is based on the Injury Severity Score (ISS), which is calculated using the Abbreviated Injury Scale in Japan. This study aimed to compare the prevalence, in-hospital mortality and OR for mortality in patients with ISS ≥16, ISS ≥18 and ISS ≥26 by age groups.Design Retrospective cohort study.Setting Japan Trauma Data Bank, which is a nationwide trauma registry with data from 280 hospitals.Participants We used data of 117 199 injured patients from a national database. We included injured patients who were transferred from the scene of injury by ambulance and/or physician.Primary and secondary outcome measures Prevalence, in-hospital mortality and OR for mortality with respect to age and injury level (ISS group).Results In all age categories, the in-hospital mortality of patient groups with an ISS ≥16, ISS ≥18 and ISS ≥26 was 13.3%, 17.4% and 23.5%, respectively. The in-hospital mortality for patients aged >75 years was the highest (20% greater than that of the other age groups). Moreover, in-hospital mortality for age group 5–14 years was the lowest (4.0–10.9%). In all the age groups, the OR for mortality for patients with ISS ≥16, ISS ≥18 and ISS ≥26 was 12.8, 11.0 and 8.4, respectively.Conclusions Our results revealed the lack of an acceptable definition, with a high in-hospital mortality and high OR for mortality for all age groups.
Keywords	Medicine ; R
Subject code	310
Language	English
Publishing date	2023-02-01T00:00:00Z
Publisher	BMJ Publishing Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Evaluation of Autonomous Actions on Bystander-Initiated Cardiopulmonary Resuscitation and Public Access Defibrillation in Tokyo.

Hirayama, Ichiro / Doi, Kent / Yamamoto, Miyuki / Toida, Chiaki / Morimura, Naoto

International heart journal

2021 Volume 62, Issue 4, Page(s) 879–884

Abstract: The frequencies of autonomous bystander-initiated cardiopulmonary resuscitation (CPR) and public access defibrillation have not yet been clarified. We aimed to evaluate the frequency of autonomous actions by citizens not having a duty to act.This ... ...

Abstract	The frequencies of autonomous bystander-initiated cardiopulmonary resuscitation (CPR) and public access defibrillation have not yet been clarified. We aimed to evaluate the frequency of autonomous actions by citizens not having a duty to act.This retrospective observational study included patients who suffered an out-of-hospital cardiac arrest (OHCA) in Tokyo between January 1, 2013 and December 31, 2017. The Delphi method with a panel of 11 experts classified the locations of OHCA resuscitations into 3 categories as follows; autonomous, non autonomous, and undetermined. The locations determined as autonomous were further divided into 2 groups; home and other locations. Bystander-initiated CPR and application of an automated external defibrillator (AED) pad were evaluated in 43,460 patients with OHCA.Group A (non autonomous), group B (autonomous, not home), and group C (home), consisted of 7,352, 3,193, and 32,915 patients, respectively. Compared with group A, group B and group C had significantly lower rates of bystander-initiated CPR (group A, B, C; 68.3% versus 38.6% versus 23.9%) and AED pad application (groups A, B, C; 26.8% versus 15.1% versus 0.6%). In addition, multivariate analysis demonstrated that an autonomous location of resuscitation was independently associated with the frequencies of bystander-initiated CPR and AED pad application, even after adjusting for age, sex, and witness status.Autonomous actions by citizens were unacceptably infrequent. Therefore, the education and training of citizens is necessary to further enhance autonomous CPR.
MeSH term(s)	Aged ; Aged, 80 and over ; Cardiopulmonary Resuscitation/instrumentation ; Cardiopulmonary Resuscitation/statistics & numerical data ; Defibrillators ; Female ; Humans ; Male ; Middle Aged ; Out-of-Hospital Cardiac Arrest/therapy ; Retrospective Studies ; Tokyo
Language	English
Publishing date	2021-07-17
Publishing country	Japan
Document type	Comparative Study ; Journal Article
ZDB-ID	2187806-7
ISSN	1349-3299 ; 1349-2365
ISSN (online)	1349-3299
ISSN	1349-2365
DOI	10.1536/ihj.21-016
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Article ; Online: Ten-year in-hospital mortality trends among Japanese injured patients by age, injury severity, injury mechanism, and injury region: A nationwide observational study.

Toida, Chiaki / Muguruma, Takashi / Gakumazawa, Masayasu / Shinohara, Mafumi / Abe, Takeru / Takeuchi, Ichiro

PloS one

2022 Volume 17, Issue 8, Page(s) e0272573

Abstract: The Injury Severity Score (ISS) is widely used in trauma research worldwide. An ISS cutoff value of ≥16 is frequently used as the definition of severe injury in Japan. The mortality of patients with ISS ≥16 has decreased in recent years, owing to the ... ...

Abstract	The Injury Severity Score (ISS) is widely used in trauma research worldwide. An ISS cutoff value of ≥16 is frequently used as the definition of severe injury in Japan. The mortality of patients with ISS ≥16 has decreased in recent years, owing to the developing the trauma care system. This study aimed to analyze the prevalence, in-hospital mortality, and odds ratio (OR) for mortality in Japanese injured patients by age, injury mechanism, injury region, and injury severity over 10 years. This study used the Japan Trauma Data Bank (JTDB) dataset, which included 315,614 patients registered between 2009 and 2018. 209,290 injured patients were utilized. This study evaluated 10-year trends of the prevalence and in-hospital mortality and risk factors associated with in-hospital mortality. The overall in-hospital mortality was 10.5%. During the 10-year study period in Japan, the mortality trend among all injured patient groups with ISS 0-15, 16-25, and ≥26 showed significant decreases (p <0.001). Moreover, the mortality risk of patients with ISS ≥26 was significantly higher than that of patients with ISS 0-15 and 16-25 (p <0.001, OR = 0.05 and p<0.001, OR = 0.22). If we define injured patients who are expected to have a mortality rate of 20% or more as severely injured, it may be necessary to change the injury severity definition according to reduction of trauma mortality as ISS cutoff values to ≥26 instead of ≥16. From 2009 to 2018, the in-hospital mortality trend among all injured patient groups with ISS 0-15, 16-25, and ≥26 showed significant decreases in Japan. Differences were noted in mortality trends and risks according to anatomical injury severity.
MeSH term(s)	Child ; Databases, Factual ; Hospital Mortality ; Humans ; Injury Severity Score ; Japan/epidemiology ; Retrospective Studies ; Risk Factors ; Wounds and Injuries
Language	English
Publishing date	2022-08-22
Publishing country	United States
Document type	Journal Article ; Observational Study ; Research Support, Non-U.S. Gov't
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0272573
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Article ; Online: The association between age and vital signs documentation of trauma patients in prehospital settings: analysis of a nationwide database in Japan.

Shinohara, Mafumi / Muguruma, Takashi / Toida, Chiaki / Gakumazawa, Masayasu / Abe, Takeru / Takeuchi, Ichiro

BMC emergency medicine

2022 Volume 22, Issue 1, Page(s) 165

Abstract: Background: Emergency medical service (EMS) providers are the first medical professionals to make contact with patients in an emergency. However, the frequency of care by EMS providers for severely injured children is limited. Vital signs are important ... ...

Abstract	Background: Emergency medical service (EMS) providers are the first medical professionals to make contact with patients in an emergency. However, the frequency of care by EMS providers for severely injured children is limited. Vital signs are important factors in assessing critically ill or injured patients in the prehospital setting. However, it has been reported that documentation of pediatric vital signs is sometimes omitted, and little is known regarding the performance rate of vital sign documentation by EMS providers in Japan. Using a nationwide data base in Japan, this study aimed to evaluate the relationship between patients' age and the documentation of vital signs in prehospital settings. Methods: This study was a secondary data analysis of the Japan Trauma Data Bank. The inclusion criterion was patients with severe trauma, as defined by an Injury Severity Score ≥ 16. Our primary outcome was the rate of recording all four basic vital signs, namely blood pressure, heart rate, respiratory rate, and level of consciousness in the prehospital setting among different age groups. We also compared the prehospital vital sign completion rate, that is, the rate at which all four vital signs were recorded in a prehospital setting based on age groups. Multivariate analysis was performed to evaluate factors associated with the prehospital vital sign completion rate. Results: We analyzed 75,777 severely injured patients. Adults accounted for 94% (71400) of these severely injured patients, whereas only 6% of patients were children. The rate of prehospital recording of vital signs was lower in children ≤5 years than in adult patients for all four vital signs. When the adult group was used as a reference, the adjusted odds ratios of vital sign completion rate in infants (0 years), younger children (1-5 years), older children (6-11 years), and teenagers (12-17 years) were 0.09, 0.30, 0.78, and 0.87, respectively. Conclusions: Analysis of the nationwide trauma registry showed that younger children tended to have a lower rate of vital sign documentation in prehospital settings.
MeSH term(s)	Adolescent ; Adult ; Child ; Documentation ; Emergency Medical Services ; Humans ; Infant ; Injury Severity Score ; Japan ; Retrospective Studies ; Vital Signs ; Wounds and Injuries/diagnosis ; Wounds and Injuries/epidemiology ; Wounds and Injuries/therapy
Language	English
Publishing date	2022-10-04
Publishing country	England
Document type	Journal Article
ZDB-ID	2050431-7
ISSN	1471-227X ; 1471-227X
ISSN (online)	1471-227X
ISSN	1471-227X
DOI	10.1186/s12873-022-00725-2
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