ArticleTrauma surgery & acute care open2020
Revision of 'golden hour' for hemodynamically unstable trauma patients: an analysis of nationwide hospital-based registry in Japan.
Article in Trauma surgery & acute care open, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 1 of them a synthesis that pooled it.
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Who cites it
15 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Prehospital Emergency Care in Low- and Middle-Income Countries: A Systematic Review.Prehospital and disaster medicine · 2023Pooled it
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- Outcomes of emergency department and operating room preperitoneal pelvic packing in hemodynamically unstable severe pelvic fractures: a retrospective risk-adjusted observational study.World journal of emergency surgery : WJES · 2026Observational
- Incident and predictors of 30-day mortality in critically ill patients after admission to the emergency department in the central region of Thailand: a prospective observational study.BMC health services research · 2026Observational
- Navigating Limitations and Clinical Challenges in Indonesian Tertiary Trauma Center for Penetrating Brain Injury: A Case Report and Literature Review.Asian journal of neurosurgery · 2025Article
- Influence of on-scene time and prehospital interventions on inhospital mortality in trauma patients.BMC emergency medicine · 2025Article
- Review
- Immediate versus expedient emergent laparotomy in unstable isolated abdominal trauma patients.Annals of the Royal College of Surgeons of England · 2025Article
- Enhancing Trauma Care in Tertiary Hospitals: Addressing Gaps and Pathways to Improvement.Emergency medicine international · 2025Article
- The effect of a clock's presence on trauma resuscitation times in a Dutch level-1 trauma center: a pre-post cohort analysis.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2024Observational
- The Multiple Functions of Melatonin: Applications in the Military Setting.Biomedicines · 2022Review
- Weather and prehospital predictors of trauma patient mortality in a rural American state.Surgery in practice and science · 2022Article
- Article
- Association of Scene Time with Mortality in Major Traumatic Injuries Arrived by Emergency Medical Service.Journal of emergencies, trauma, and shockArticle
- Beyond rural: A time-based measure for urban, rural, remote, and geographically isolated response.The journal of climate change and healthArticle
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe 'golden hour' is a well-known concept, suggesting that shortening time from injury to definitive care is critically important for better outcome of trauma patients. However, there was no established evidence to support it. We aimed to validate the association between time to definitive care and mortality in hemodynamically unstable patients for the current trauma care settings.
methodsThe data were collected from the Japan Trauma Data Bank between 2006 and 2015. The inclusion criteria were patients with systolic blood pressure (SBP) <90 mm Hg and heart rate (HR) >110 beats/min or SBP <70 mm Hg who underwent definitive care within 4 hours from the onset of injury and survived for more than 4 hours. The outcome measure was in-hospital mortality. We evaluated the relationship between time to definitive care and mortality using the generalized additive model (GAM). Subgroup analysis was also conducted using GAM after dividing the patients into the severe (SBP <70 mm Hg) and moderate (SBP ≥70 mm Hg and <90 mm Hg, and HR >110 beats/min) shock group.
results1169 patients were enrolled in this study. Of these, 386 (33.0%) died. Median time from injury to definitive care was 137 min. Only 61 patients (5.2%) received definitive care within 60 min. The GAM models demonstrated that mortality remained stable for the early phase, followed by a decrease over time. The severe shock group presented with a paradoxical decline of mortality with time, whereas the moderate shock group had a time-dependent increase in mortality. DISCUSSION: We did not observe the association of shorter time to definitive care with a decrease in mortality. However, this was likely an offset result of severe and moderate shock groups. The result indicated that early definitive care could have a positive impact on survival outcome of patients with moderate shock. LEVEL OF EVIDENCE: Level Ⅳ, prognostic study.
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