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Multicenter Study
. 2019 Jul 30;9(7):e029706.
doi: 10.1136/bmjopen-2019-029706.

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

Yohei Okada  1   2   3 , Takeyuki Kiguchi  2 , Ryoji Iiduka  3 , Wataru Ishii  3 , Taku Iwami  2 , Kaoru Koike  4
Affiliations
Multicenter Study

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

Yohei Okada et al. BMJ Open. .

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.

Keywords: JCS; JPTEC; injury; prehospital.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Flow chart of patient selection for the study. JCS, Japan Coma Scale; JTDB, Japan Trauma Data Bank.
See this image and copyright information in PMC

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