{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:19:42Z","timestamp":1760145582729,"version":"build-2065373602"},"reference-count":31,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2024,8,18]],"date-time":"2024-08-18T00:00:00Z","timestamp":1723939200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Minimally invasive trauma management, including interventional radiology and non-operative approaches, has proven effective. Consequently, our hospital established a trauma IVR protocol called \u201cOhta Nishinouchi Hospital trauma protocol (ONH trauma protocol) in 2013, mainly for trunk trauma. However, the efficacy of the ONH trauma protocol has remained unverified. We aimed to assess the protocol\u2019s impact using interrupted time-series analysis (ITSA). Materials and Methods: This retrospective cohort study was conducted at Ohta Nishinouchi hospital, a tertiary emergency hospital, from January 2004 to December 2019. We included patients aged \u2265 18 years who presented to our institution due to severe trauma characterized by an Abbreviated Injury Scale of \u22653 in any region. The primary outcome was the incidence of in-hospital deaths per 100 transported patients with trauma. Multivariable logistic regression analysis was conducted with in-hospital mortality as the outcome, with no exposure before protocol implementation and with exposure after protocol implementation. Results: Overall, 4558 patients were included in the analysis. The ITSA showed no significant change in in-hospital deaths after protocol induction (level change \u22121.49, 95% confidence interval (CI) \u22124.82 to 1.84, p = 0.39; trend change \u22120.044, 95% CI \u22120.22 to 0.14, p = 0.63). However, the logistic regression analysis revealed a reduced mortality effect following protocol induction (odds ratio: 0.50, 95% CI: 0.37 to 0.66, p &lt; 0.01, average marginal effects: \u22123.2%, 95% CI: \u22124.5 to \u22122.0, p &lt; 0.01). Conclusions: The ITSA showed no association between the protocol and mortality. However, before-and-after testing revealed a positive impact on mortality. A comprehensive analysis, including ITSA, is recommended over before-and-after comparisons to assess the impact of the protocol.<\/jats:p>","DOI":"10.3390\/medicina60081338","type":"journal-article","created":{"date-parts":[[2024,8,19]],"date-time":"2024-08-19T03:43:28Z","timestamp":1724039008000},"page":"1338","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Evaluation of the Impact of a Less-Invasive Trunk and Pelvic Trauma Protocol on Mortality in Patients with Severe Injury by Interrupted Time-Series Analysis"],"prefix":"10.3390","volume":"60","author":[{"given":"Tokiya","family":"Ishida","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Emergency Medicine, Ohta Nishinouchi Hospital, Fukushima 963-8558, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0702-0392","authenticated-orcid":false,"given":"Yudai","family":"Iwasaki","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Emergency Medicine, Ohta Nishinouchi Hospital, Fukushima 963-8558, Japan"},{"name":"Department of Anesthesiology and Perioperative Medicine, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5144-6585","authenticated-orcid":false,"given":"Ryohei","family":"Yamamoto","sequence":"additional","affiliation":[{"name":"Center for Innovative Research for Communities and Clinical Excellence (CIRC2LE), Fukushima Medical University, Fukushima 960-1295, Japan"},{"name":"Department of Healthcare Epidemiology, School of Public Health, Graduate School of Medicine, Kyoto University, Kyoto 606-8501, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nozomi","family":"Tomita","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Emergency Medicine, Ohta Nishinouchi Hospital, Fukushima 963-8558, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kazuaki","family":"Shinohara","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Emergency Medicine, Ohta Nishinouchi Hospital, Fukushima 963-8558, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kaneyuki","family":"Kawamae","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Emergency Medicine, Ohta Nishinouchi Hospital, Fukushima 963-8558, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8708-6852","authenticated-orcid":false,"given":"Masanori","family":"Yamauchi","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,8,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1055\/s-2006-948766","article-title":"The Role of Interventional Radiology in Trauma","volume":"23","author":"Gould","year":"2006","journal-title":"Semin. Intervent. Radiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1186\/s13017-022-00457-5","article-title":"Follow-up Strategies for Patients with Splenic Trauma Managed Non-Operatively: The 2022 World Society of Emergency Surgery Consensus Document","volume":"17","author":"Podda","year":"2022","journal-title":"World J. Emerg. Surg."},{"key":"ref_3","unstructured":"(2024, May 21). Trauma Programs. Available online: https:\/\/www.facs.org\/quality-programs\/trauma\/."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/s13049-018-0578-y","article-title":"Hospital Level variations in the trends and outcomes of the nonoperative management of splenic injuries\u2014A nationwide cohort study","volume":"27","author":"Liao","year":"2019","journal-title":"Scand. J. Trauma Resusc. Emerg. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e000551","DOI":"10.1136\/tsaco-2020-000551","article-title":"Evolution of non-operative management of liver trauma","volume":"5","author":"Brooks","year":"2020","journal-title":"Trauma Surg. Acute Care Open"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Uberoi, R. (2009). Interventional Radiology. Oxford Specialist Handbooks in Radiology, Oxford University Press.","DOI":"10.1093\/med\/9780199547722.001.0001"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1097\/TA.0b013e3182946649","article-title":"Predicting extubation failure in blunt trauma patients with pulmonary contusion","volume":"75","author":"Bilello","year":"2013","journal-title":"J. Trauma Acute Care Surg."},{"key":"ref_8","first-page":"626","article-title":"Observation for nonoperative management of blunt liver injuries: How long is long enough?","volume":"70","author":"Parks","year":"2011","journal-title":"J. Trauma"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1127","DOI":"10.1097\/TA.0b013e3182569849","article-title":"Selective angiographic embolization of blunt splenic traumatic injuries in adults decreases failure rate of nonoperative management","volume":"72","author":"Bhullar","year":"2012","journal-title":"J. Trauma Acute Care Surg."},{"key":"ref_10","first-page":"1219","article-title":"What are the specific computed tomography scan criteria that can predict or exclude the need for renal angioembolization after high-grade renal trauma in a conservative management strategy?","volume":"70","author":"Charbit","year":"2011","journal-title":"J. Trauma"},{"key":"ref_11","first-page":"1850","article-title":"Eastern Association for the Surgery of Trauma practice management guidelines for hemorrhage in pelvic fracture\u2014Update and systematic review","volume":"71","author":"Cullinane","year":"2011","journal-title":"J. Trauma"},{"key":"ref_12","unstructured":"Feliciano, D.V., Mattox, K.L., and Moore, E.E. (2013). Trauma, McGraw-Hill Education. [7th ed.]."},{"key":"ref_13","unstructured":"American Association for the Surgery of Trauma (2024, July 10). Injury Scoring Scale, n.d. Available online: https:\/\/www.aast.org\/resources-detail\/injury-scoring-scale."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"137","DOI":"10.4103\/picr.PICR_91_19","article-title":"Study Designs: Part 4\u2014Interventional Studies","volume":"10","author":"Aggarwal","year":"2019","journal-title":"Perspect. Clin. Res."},{"key":"ref_15","first-page":"348","article-title":"Interrupted Time Series Regression for the Evaluation of Public Health Interventions: A Tutorial","volume":"46","author":"Cummins","year":"2016","journal-title":"Int. J. Epidemiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2946","DOI":"10.1016\/j.injury.2020.09.025","article-title":"Severe Traffic Injuries in the Helsinki Trauma Registry between 2009\u20132018","volume":"51","author":"Airaksinen","year":"2020","journal-title":"Injury"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1097\/00005373-197403000-00001","article-title":"The Injury Severity Score: A Method for Describing Patients with Multiple Injuries and Evaluating Emergency Care","volume":"14","author":"Baker","year":"1974","journal-title":"J. Trauma"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1097\/00005373-198905000-00017","article-title":"A Revision of the Trauma Score","volume":"29","author":"Champion","year":"1989","journal-title":"J. Trauma"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1097\/00005373-198704000-00005","article-title":"Evaluating Trauma Care: The TRISS Method","volume":"27","author":"Boyd","year":"1987","journal-title":"J. Trauma"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1097\/00000658-199110000-00015","article-title":"Analyses of Preventable Deaths by Mechanism of Injury among 13,500 Trauma Admissions","volume":"214","author":"Cayten","year":"1991","journal-title":"Ann. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1186\/s13049-019-0589-3","article-title":"Is there an association between female gender and outcome in severe trauma? A multi-center analysis in the Netherlands","volume":"27","author":"Pape","year":"2019","journal-title":"S. J. Trauma Resusc. Emerg. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1177\/1460408618781412","article-title":"Splenic Artery Embolisation in Trauma: A Five-Year Single-Centre Experience at a UK Major Trauma Centre","volume":"21","author":"Davies","year":"2019","journal-title":"Trauma"},{"key":"ref_23","first-page":"146","article-title":"Policy bubbles","volume":"42","author":"Jones","year":"2014","journal-title":"Policy Stud. J. J. Policy Stud. Organ."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1186\/s13049-016-0218-3","article-title":"Effect of an Organizational Change in a Prehospital Trauma Care Protocol and Trauma Transport Directive in a Large Urban City: A before and after Study","volume":"24","author":"Ponzer","year":"2016","journal-title":"Scand. J. Trauma Resusc. Emerg. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"764","DOI":"10.1111\/j.1553-2712.1997.tb03781.x","article-title":"Rural Hospital Transfer Patterns before and after Implementation of a Statewide Trauma System","volume":"4","author":"Mann","year":"1997","journal-title":"Acad. Emerg. Med."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Linden, A. (2013). Assessing Regression to the Mean Effects in Health Care Initiatives. BMC Med. Res. Methodol., 13.","DOI":"10.1186\/1471-2288-13-119"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"199","DOI":"10.11613\/BM.2014.022","article-title":"Observational and Interventional Study Design Types; an Overview","volume":"24","author":"Thiese","year":"2014","journal-title":"Biochem. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1186\/cc13740","article-title":"Implementing Evidence-Based Practice in the Neuroscience Intensive Care Unit","volume":"18","author":"Elmer","year":"2014","journal-title":"Crit. Care"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"S38","DOI":"10.1016\/j.acap.2013.08.002","article-title":"Use of Interrupted Time Series Analysis in Evaluating Health Care Quality Improvements","volume":"13","author":"Penfold","year":"2013","journal-title":"Acad. Pediatr."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1016\/j.jamcollsurg.2016.10.051","article-title":"Assessment of Progress in Early Trauma Care in Japan over the Past Decade: Achievements and Areas for Future Improvement","volume":"224","author":"Endo","year":"2017","journal-title":"J. Am. Coll. Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1016\/j.iatssr.2016.01.003","article-title":"Achieving safe road traffic\u2014The experience in Japan","volume":"39","author":"Oguchi","year":"2016","journal-title":"IATSS Res."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/8\/1338\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:38:23Z","timestamp":1760110703000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/8\/1338"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,18]]},"references-count":31,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2024,8]]}},"alternative-id":["medicina60081338"],"URL":"https:\/\/doi.org\/10.3390\/medicina60081338","relation":{},"ISSN":["1648-9144"],"issn-type":[{"type":"electronic","value":"1648-9144"}],"subject":[],"published":{"date-parts":[[2024,8,18]]}}}