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Comparison of trauma outcomes between Japan and the USA using national trauma registries
  1. Shokei Matsumoto1,2,
  2. Kyoungwon Jung1,3,
  3. Alan Smith1,
  4. Motoyasu Yamazaki2,
  5. Mitsuhide Kitano2,
  6. Raul Coimbra4
  1. 1 Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, University of California San Diego, San Diego, California, USA
  2. 2 Department of Trauma and Emergency Surgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
  3. 3 Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine, Suwon, South Korea
  4. 4 Riverside University Health System Medical Center and Loma Linda University School of Medicine, Riverside, California, USA
  1. Correspondence to Dr Raul Coimbra, Riverside University Health System Medical Centerx, Moreno Valley, CA 92555, USA; raulcoimbra62{at}


Background The National Trauma Data Bank (NTDB) has served as a global benchmark for trauma care quality and outcomes. Herein, we compared patient characteristics, trauma management, and outcomes between Japanese emergency and critical care centers and US level 1 trauma centers using the Japanese Trauma Data Bank (JTDB) and NTDB.

Methods A retrospective cohort matching (1:1) study was performed. Patients treated in 2013 with an Injury Severity Score ≥9 were included. The primary outcome measure was in-hospital mortality. The secondary outcome measures included the hospital length of stay and the rate of use of radiological diagnostic modalities.

Results A total of 14 960 pairs with well-balanced characteristics were generated from 22 535 and 112 060 eligible patients in the JTDB and NTDB, respectively. Before matching, the in-hospital mortality was higher in the JTDB than in the NTDB (7.6% vs. 6.1%; OR, 1.28; 95% CI 1.21 to 1.35). However, after matching, the in-hospital mortality was lower in the JTDB cohort (4.2% vs. 5.8%; OR, 0.72; 95% CI 0.65 to 0.80). CT scans were used in >80% of JTDB patients, which was more than 1.5 times as often as the use in the NTDB cohort. In subgroup analyses, only patients who received a blood transfusion had a poorer survival outcome in the JTDB compared with the NTDB (OR, 1.32; 95% CI 1.07 to 1.64).

Discussion We observed marked differences in trauma care between Japan and the USA. Although the quality of the recent Japanese trauma care appears to be approaching that of the USA, it may be further improved, such as by the establishment of transfusion protocols.

Level of evidence Level IV.

  • trauma/ critical care
  • japan
  • comparison
  • united states

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  • Contributors Study conception and design: SM, KJ, RC. Acquisition of data: SM, KJ, AS. Analysis and interpretation of data: SM, AS, MY, RC. Drafting of the article: SM, RC. Critical revision: SM, KJ, RC, MK.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval This retrospective study was approved by our institutional review board (UCSD Human Research Protections Program, Project #151611X).

  • Provenance and peer review Not commissioned; internally peer reviewed.

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