Revised trauma scoring system to predict in-hospital mortality in the emergency department: Glasgow Coma Scale, Age, and Systolic Blood Pressure score

Introduction: Our aim in this study was to assess whether the new Glasgow Coma Scale, Age, and Systolic Blood Pressure (GAP) scoring system, which is a modification of the Mechanism, Glasgow Coma Scale, Age, and Arterial Pressure (MGAP) scoring system, better predicts in-hospital mortality and can be applied more easily than previous trauma scores among trauma patients in the emergency department (ED). Methods: This multicenter, prospective, observational study was conducted to analyze readily available variables in the ED, which are associated with mortality rates among trauma patients. The data used in this study were derived from the Japan Trauma Data Bank (JTDB), which consists of 114 major emergency hospitals in Japan. A total of 35,732 trauma patients in the JTDB from 2004 to 2009 who were 15 years of age or older were eligible for inclusion in the study. Of these patients, 27,154 (76%) with complete sets of important data (patient age, Glasgow Coma Scale (GCS) score, systolic blood pressure (SBP), respiratory rate and Injury Severity Score (ISS)) were included in our analysis. We calculated weight for the predictors of the GAP scores on the basis of the records of 13,463 trauma patients in a derivation data set determined by using logistic regression. Scores derived from four existing scoring systems (Revised Trauma Score, Triage Revised Trauma Score, Trauma and Injury Severity Score and MGAP score) were calibrated using logistic regression models that fit in the derivation set. The GAP scoring system was compared to the calibrated scoring systems with data from a total of 13,691 patients in a validation data set using c-statistics and reclassification tables with three defined risk groups based on a previous publication: low risk (mortality 50%). Results: Calculated GAP scores involved GCS score (from three to fifteen points), patient age 120 mmHg, six points; 60 to 120 mmHg, four points). The c-statistics for the GAP scores (0.933 for long-term mortality and 0.965 for short-term mortality) were better than or comparable to the trauma scores calculated using other scales. Compared with existing instruments, our reclassification tables show that the GAP scoring system reclassified all patients except one in the correct direction. In most cases, the observed incidence of death in patients who were reclassified matched what would have been predicted by the GAP scoring system. Conclusions: The GAP scoring system can predict in-hospital mortality more accurately than the previously developed trauma scoring systems

Artificial Intelligence, Robots, and Philosophy

This book is a collection of all the papers published in the special issue “Artificial Intelligence, Robots, and Philosophy,” Journal of Philosophy of Life, Vol.13, No.1, 2023, pp.1-146. The authors discuss a variety of topics such as science fiction and space ethics, the philosophy of artificial intelligence, the ethics of autonomous agents, and virtuous robots. Through their discussions, readers are able to think deeply about the essence of modern technology and the future of humanity. All papers were invited and completed in spring 2020, though because of the Covid-19 pandemic and other problems, the publication was delayed until this year. I apologize to the authors and potential readers for the delay. I hope that readers will enjoy these arguments on digital technology and its relationship with philosophy. *** Contents*** Introduction : Descartes and Artificial Intelligence; Masahiro Morioka*** Isaac Asimov and the Current State of Space Science Fiction : In the Light of Space Ethics; Shin-ichiro Inaba*** Artificial Intelligence and Contemporary Philosophy : Heidegger, Jonas, and Slime Mold; Masahiro Morioka*** Implications of Automating Science : The Possibility of Artificial Creativity and the Future of Science; Makoto Kureha*** Why Autonomous Agents Should Not Be Built for War; István Zoltán Zárdai*** Wheat and Pepper : Interactions Between Technology and Humans; Minao Kukita*** Clockwork Courage : A Defense of Virtuous Robots; Shimpei Okamoto*** Reconstructing Agency from Choice; Yuko Murakami*** Gushing Prose : Will Machines Ever be Able to Translate as Badly as Humans?; Rossa Ó Muireartaigh**

Association of Nights and Weekends with Survival of Traumatic Out-of-Hospital Cardiac Arrest following Traffic Collisions: Japanese Registry-Based Study

Background: The process of care for traumatic out-of-hospital cardiac arrest (OHCA) may be different at night and on the weekend. However, little is known about whether the rate of survival after OHCA is affected by the time of day and day of the week. Methods: This observational study analyzed the Japanese government-led nationwide population-based registry data of OHCA patients. Patients who experienced traumatic OHCA following traffic collisions from 2013 to 2017 were included in the study. A multivariable logistic regression model was used to examine the association of both time of day (day/evening vs. night) and day of the week (weekday vs. weekend) with outcomes after traumatic OHCA. Night was defined as 23:00 p.m. to 6:59 a.m., and weekends were defined as Saturday and Sunday. The primary outcome was one-month survival. Results: A total of 8500 patients (mean [SD] age, 57.7 [22.3] years; 68.6% male) were included. 2267 events (26.7%) occurred at night, and 2482 events (29.2%) occurred on weekends. Overall, 173 patients (2.0%) survived one month after OHCA. After adjusting for potential confounders, one-month survival during the day/evening (148/6233 [2.4%]) was significantly higher than during the night (25/2267 [1.1%]) (adjusted OR, 1.95 [95%CI, 1.24–3.07]), whereas there was no significant difference in one-month survival between weekdays (121/6018 [2.0%]) and weekends (52/2482 [2.1%]) (adjusted OR, 0.97 [95%CI, 0.69–1.38]). Conclusions: One-month survival after traumatic OHCA was significantly lower during the night than during the day/evening, although there was no difference in one-month survival between weekdays and weekends. Further studies are warranted to investigate the underlying mechanisms of decreased survival at night