Hemodynamically unstable trauma patients who received definitive care within 4 hours from the onset of injury were enrolled in this study. A dataset provided from JTDB was anonymized. Data consisted of demographics, injury severity characteristics, time course (EMS calls, arrival at hospitals, initiating definitive care and so on), type of initial procedures and definitive care and course of hospitalization. We collected the sample for the study from the JTDB for the period from 2006 to 2015. The registry contains data of patients with trauma who had an injury of a three or more on the Abbreviated Injury Scale (AIS) in at least one body region. The data were collected from the Japan Trauma Data Bank (JTDB), which is a prospective multicenter trauma registry that includes more than 260 institutions in Japan. We also aimed to identify patients who could benefit from earlier definitive care by hemodynamic status. The objective of this study was to clarify the exact relationship between elapsed time and mortality for the current trauma care settings. Therefore, the optimal target and management should be revised in the current settings. 5 6 Another point is that trauma care strategies have been drastically developed over the last decades, for example, resuscitative endovascular balloon occlusion of the aorta (REBOA), massive transfusion and helicopter emergency medical service (EMS). 4 However, a few studies have suggested that limited patients, who had hypotension requiring critical intervention, could benefit from minimizing out-of-hospital time. The recent systematic review has concluded that there was no established evidence supporting this principle for patients with undifferentiated trauma. 3 However, it has been widely accepted with clinical plausibility. 1 2 This concept was developed in 1970s without any data or reference. The ‘golden hour’ is a concept that critically injured patients are required to receive definitive care within 60 min from the occurrence of injuries, after which mortality significantly increased. Time management is considered as a key factor to reduce mortality in trauma patients.

The golden hour time