Injuries In Japan Research Articles

Assessing associated factors for failure of nonoperative management in pediatric blunt liver and spleen injuries: a secondary analysis of the SHIPPs study.

The purpose of this study was to describe the characteristics of pediatric patients who underwent nonoperative management (NOM) for blunt splenic and hepatic injuries and to explore factors associated with NOM failure. This was a secondary analysis of a multicenter cohort study of pediatric patients with blunt liver and spleen injuries in Japan. Participants included pediatric trauma patients aged 16years or younger between 2008 and 2019 with NOM, which was defined as no surgery provided within 6h of hospital arrival. NOM failure, defined as abdominal surgery performed after 6h of hospital arrival, was the primary outcome. Descriptive statistics were provided and exploratory analysis to assess the associations with outcome using logistic regression. During the study period, 1339 met our eligibility criteria. The median age was 9years, with a majority being male. The median Injury Severity Score (ISS) was 10. About 14.0% required transfusion within 24h, and 22.3% underwent interventional radiology procedures. NOM failure occurred in 1.0% of patients and the in-hospital mortality was 0.7%. Factors associated with NOM failure included age, positive focused assessment with sonography for trauma (FAST), contrast extravasation on computed tomography (CT), severe liver injury, concomitant pancreas injury, concomitant gastrointestinal injury, concomitant mesenteric injury, and ISS. In our study, NOM failure were rare. Older age, positive FAST, contrast extravasation on CT, severe liver injury, concomitant pancreas injury, concomitant gastrointestinal injury, concomitant mesenteric injury, and higher ISS were suggested as possible risk factors for NOM failure.

Proctoring System Enables Safe Induction of Robotic Gastrectomy: Short-term Outcomes of the First 10 Cases.

The Japan Society of Endoscopic Surgery (JSES) proctoring system was established to prevent serious pancreatic pressure injuries in Japan in 2019. To safely perform robotic gastrectomy (RG) in our hospital, which has no experience in robotic surgery, we conducted a clinical trial with the support of this proctoring system. The present study was a single-center clinical prospective study. The primary endpoint was morbidity determined using Clavien-Dindo classification (C-D) Grade IIIa or higher. Ten patients, seven males and three females, were recruited in this study. RG was performed under the proctoring system of the JSES in the initial six cases and was completed independently for the remaining four patients. We successfully performed the initial ten cases without C-D classification grade IIIa or higher morbidities. This study underscores the significance of a proctoring system for introducing RG to facilities with limited experience in robotic surgery. Despite some limitations, this study demonstrated successful outcomes in the initial ten cases, emphasizing the benefits for both surgeons and patients. This study provides valuable insights into the safety of RG in small institutions and calls for further research in this area.

Factors associated with prolonged on-scene time in ambulance transportation among patients with minor diseases or injuries in Japan: a population-based observational study

BackgroundProlonged prehospital time is a major global problem in the emergency medical system (EMS). Although factors related to prolonged on-scene times (OSTs) have been reported in patients with trauma and critical medical conditions, those in patients with minor diseases or injuries remain unclear. We examined factors associated with prolonged OSTs in patients with minor diseases or injuries.MethodsThis population-based observational study used the ambulance transportation and request call record databases of the Higashihiroshima Fire Department, Japan, between January 1, 2016, and December 31, 2022. The participants were patients with minor diseases or injuries during the study period. We performed a multivariable logistic regression analysis with robust error variance to examine the association between patient age, sex, severity, accident type, date and time of ambulance call, and the coronavirus disease 2019 (COVID-19) pandemic with prolonged OSTs. Prolonged OST was defined as ≥ 30 min from the ambulance arrival at the scene to departure.ResultsOf the 60,309 people transported by ambulance during the study period, 20,069 with minor diseases or injuries were included in the analysis. A total of 1,241 patients (6.2%) experienced prolonged OSTs. Fire accidents (adjusted odds ratio [aOR]: 7.77, 95% confidence interval [CI]: 3.82–15.79), natural disasters (aOR: 28.52, 95% CI: 2.09–389.76), motor vehicle accidents (aOR: 1.63, 95% CI: 1.30–2.06), assaults (aOR: 2.91, 95% CI: 1.86–4.53), self-injuries (aOR: 5.60, 95% CI: 3.37–9.32), number of hospital inquiries ≥ 4 (aOR: 77.34, 95% CI: 53.55–111.69), and the COVID-19 pandemic (aOR: 2.01, 95% CI: 1.62–2.50) were associated with prolonged OSTs. Moreover, older and female patients had prolonged OSTs (aOR: 1.18, 95% CI: 1.01–1.36 and aOR: 1.12, 95% CI: 1.08–1.18, respectively).ConclusionsOlder age, female sex, fire accidents, natural disasters, motor vehicle accidents, assaults, self-injuries, number of hospital inquiries ≥ 4, and the COVID-19 pandemic influenced prolonged OSTs among patients with minor diseases or injuries. To improve community EMS, we should reconsider how to intervene with potentially modifiable factors, such as EMS personnel performance, the impact of the presence of allied services, hospital patient acceptance systems, and cooperation between general emergency and psychiatric hospitals.

Vision-Based Robot Arm Control Interface for Retrieving Objects from the Floor

Approximately half of the patients with spinal cord injuries in Japan have a cervical spinal cord injury. Owing to the trunk dysfunction, patients with high-level spinal cord injuries have particular difficulty when searching for or picking up objects from the floor. Recently, welfare robot arms have been developed to help such individuals increase self-reliance. In this study, we propose an operating system that includes an eye-in-hand system with a touchscreen interface for grasping objects from the floor and delivering them to the individual. In the proposed method, the visual information of the target object is shown on a touchscreen interface. The patient specifies the target position for the robot arm by drawing a line on the target object on the interface. We conducted an experiment to compare the proposed interface with an on-screen joystick to demonstrate the proposed system’s efficiency and its ability to reduce physical burden. The results show that the proposed method is both quicker to use and effectively reduces the physical burden on the user compared to the conventional method.

Risk factors for fracture by same-level falls among workers across sectors: a cross-sectional study of national open database of the occupational injuries in Japan

ObjectivesThe hospitalisation rate for work-related injuries among older workers is double that of younger workers; however, the risk factors for same-level fall fractures sustained during industrial accidents remain unclear. This study aimed to estimate the influence of worker age, time of day and weather conditions on the risk of same-level fall fractures in all industrial sectors in Japan. Study designThis was a cross-sectional study. MethodsThis study used the population-based national open database of worker death and injury reports in Japan. In total, 34,580 reports of occupational same-level falls between 2012 and 2016 were used in this study. Multiple logistic regression analysis was performed. ResultsIn primary industries, workers aged ≥55 years had a 1.684 times greater risk of fracture (95% confidence interval [CI]: 1.167–2.430) compared with workers aged ≤54 years. In tertiary industries, relative to the odds ratio (OR) of injuries recorded at 0:00–2:59 a.m., the ORs recorded at 6:00–8:59 p.m., 6:00–8:59 a.m., 9:00–11:59 p.m. and 0:00–2:59 p.m. were 1.516 (95% CI: 1.202, 1.912), 1.502 (95% CI: 1.203–1.876), 1.348 (95% CI: 1.043–1.741) and 1.295 (95% CI: 1.039–1.614), respectively. The risk of fracture increased with a 1-day increase in the number of snowfall days were per month in secondary (OR = 1.056, 95% CI: 1.011–1.103) and tertiary (OR = 1.034, 95% CI: 1.009–1.061) industries. The risk of fracture decreased with every 1-degree increase in the lowest temperature in primary (OR = 0.967, 95% CI: 0.935–0.999) and tertiary (OR = 0.993, 95% CI: 0.988–0.999) industries. ConclusionsWith the increasing number of older workers and changing environmental conditions, the risk of falls in the tertiary sector industries is increasing, particularly just before and just after shift change hours. These risks may be associated with environmental obstacles during work migration. It is also important to consider the weather-associated risks of fracture.

Wood-Splitter-Related Upper-Limb Injuries: A Single-Centered Case-Series Study.

(1) Background: Injuries to the upper limbs during wood splitting can affect social and economic life. We aimed to describe the clinical information concerning these injuries in Japan. (2) Methods: We identified patients from our patient database from April 2015–November 2021 and extracted data from their medical records, which includes age, gender, occupation, month, time and location of the injury, diagnosis, duration of hospitalization, ICU admission, treatment interventions including surgery, outcome, and medical costs. (3) Result: Seventeen cases were identified. Most of the patients were male (n = 15), with median age being 68 years old. Regarding the patients’ backgrounds, six were apple farmers and three were unemployed. Injuries to the index finger was most common (n = 9), followed by injuries to the thumb in five cases (n = 5). Most of the incidents occurred at home or on the patient’s farm estate. No injuries were due to incidents at work. (4) Conclusion: The wood splitter-related injuries required long-term treatment and frequently damaged the thumb, a functionally important digit. All the injuries were sustained during non-occupational use of a wood splitter. Therefore, we suggest that safety training should be provided to prevent traumatic injuries when these products are being sold.

A 19-Year Study of Dental Needlestick and Sharps Injuries in Japan

BackgroundNeedlestick and sharps injuries (NSIs) are serious problems for dental health care workers (DHCWs) because they are at risk for occupational blood-borne infections. In this study, risk factors for NSIs in DHCWs at Tohoku University Hospital (TUH) in Japan over 19 years were analysed. MethodsNSI data of DHCWs at TUH from April 2002 to March 2020 were collected from the Exposure Prevention Information Network (EPINet) and statistically analysed. ResultsA total of 195 NSIs occurred during the 19-year study period. Approximately 58.5% of NSIs occurred in DHCWs with less than 5 years of experience. Injection needles were the most frequent cause of NSIs (19.0%) followed by suture needles (13.3%) and ultrasonic scaler chips (12.8%). Needle injuries occurred mainly on the left hand, whereas ultrasonic scaler chip and bur injuries occurred on the right hand and other body parts whilst DHCWs were placing the instruments back on the dental unit hanging holder without removing the sharps. NSIs from other instruments primarily occurred on both hands and foot insteps during cleanup. No case of occupational blood-borne infection caused by NSIs was observed during the study period at TUH. ConclusionsNSIs occurred in DHCWs with less experience, and there were associations between the instruments, timing of use, and NSI site. EPINet was considered a valuable tool for monitoring NSIs in order to develop future strategies for minimising NSIs.

Verification of clinical usefulness of “GRASSP” for cervical spinal cord injuries in Japan

Verification of clinical usefulness of “GRASSP” for cervical spinal cord injuries in Japan

Japanese Society for Burn Injuries (JSBI) Clinical Practice Guidelines for Management of Burn Care (3rd Edition)

The Japanese Society for Burn Injuries (JSBI) published the third edition of guidelines to present the standard of care for inpatient treatment of burn injuries in Japan. The guideline is not a mere revision of the first and second editions but has been carefully designed to be user friendly and of high quality for medical professionals engaged in burn care. We think it is important to share these guidelines with other countries to work toward a consensus of burn care, then develop new research to establish evidence for burn care and treatment in the future.

腹部外傷におけるDamage Control Surgeryの適応基準の検討

腹部外傷におけるDamage Control Surgeryの適応基準の検討

Area-Wide Traffic-Calming Zone 30 Policy of Japan and Incidence of Road Traffic Injuries Among Cyclists and Pedestrians.

Objectives. To quantify the impact of the "Zone 30" policy introduced in September 2011 on the incidence of cyclist and pedestrian injuries in Japan.Methods. This was an interrupted time-series study. We used the data of cyclist and pedestrian injuries recorded by the Japanese police between 2005 and 2016. We evaluated the monthly number of deaths and serious injuries per person-time on narrow roads (width < 5.5 m, subjected to the policy) compared with that on wide roads (≥ 5.5 m) to control for secular trends. We regressed the injury rate ratio on 2 predictors: the numbers of months after January 2005 and after September 2011. Using the regression results, we estimated the number of deaths and serious injuries prevented.Results. There were 266 939 deaths and serious injuries. By 2016, the cumulative changes in the rate ratio spanned from -0.26 to -0.046, depending on sex and age, and an estimated number of 1704 (95% confidence interval = 1293, 2198) injuries were prevented.Conclusions. The policy had a large preventive impact on cyclist and pedestrian deaths and serious injuries at the national level.

Rehabilitation Medicine for Spinal Cord Injuries in Japan

脊髄損傷のリハビリテーション医療の課題は，現在の医療制度における「在院日数の短縮」と脊髄損傷者の「受傷時年齢の高齢化と障害の重度化」への対応である．在院日数の問題は，複数の医療機関が連携を密にし，脊髄損傷者個々の長期ゴールを明確にしたうえでそれぞれが役割を果たすことで克服できる．さらに，高齢化と重度化に対しては，若年の対麻痺者とは異なり地域医療を主体として社会復帰までの流れを築くことで対応する．

Influence of the Fukushima Daiichi Nuclear Power Plant Accident on the Use of Computed Tomography in Children with Mild Head Injuries: A Retrospective Cohort Study

Background: Although computed tomography (CT) may induce cancer, CT seems to be commonly used in children with mild head injuries in Japan. People in Japan are concerned about radiation exposure and radiation-induced cancer because of the Fukushima Daiichi Nuclear Power Plant accident following the Great East Japan Earthquake and Tsunami on March 11, 2011. This study investigated whether the accident influenced the use of CT in children with mild head injuries. Methods: Using the Japan Medical Data Center database, we identified patients aged 15 years or younger who visited clinics because of mild head injuries from January 1, 2008, to December 31, 2013. We excluded patients who were admitted to the hospital or received other medical examinations. Regression discontinuity analysis was used to compare proportions of patients undergoing head CT and having clinically important traumatic brain injury (ciTBI) overlooked before vs. after the accident, adjusting for patient characteristics, secular trends, and clinic effect. Findings: Eligible patients (n = 40,440) were classified as visiting the clinic before (n = 11,659) or after (n = 28,781) the accident. The regression discontinuity analysis showed that the accident was significantly associated with a reduction in the proportion of patients undergoing head CT (odds ratio: 0·73; 95% confidence interval: 0·63-0·86; P < 0·001), whereas the accident was not significantly associated with an increase in cases where ciTBI was overlooked (odds ratio: 0·72; 95% confidence interval: 0·13-4·00; P = 0·710). Similar associations were shown in sensitivity analyses with different bandwidths. Interpretation: The use of CT in children with mild head injuries declined significantly after the Fukushima Daiichi Nuclear Power Plant accident, and there was no increase in ciTBI being overlooked. People's concerns about radiation exposure can reduce unnecessary CT. Funding: Nothing. Declaration of Interest: HY received grant support from the Japanese government. The authors declare that they have no competing interests. Ethical Approval: The study was approved by the Institutional Review Board of the University of Tokyo.

Clinical characteristics and outcomes of open globe injuries in Japan.

To describe the epidemiology and clinical outcomes of open globe injuries (OGIs) in Japan over 10 years, and examine preoperative factors influencing the visual prognosis after surgery. Retrospective, observational, multicenter case-series study. Patients' data were entered into a computerized database for review and statistical analyses. The following parameters were assessed; age, gender, initial and final visual acuity, duration between onset and surgery, presence of lens in the eye, characteristics of injury, presence of ocular complications, and number of surgeries. The records of 374 eyes with OGI were enrolled. The average age of the patients was 56.8 ± 22.1 years, and the majority of patients were men (73.5%). Compared to the overall cohort, work-related OGI was the most common, associated with significantly better final visual acuity, whereas patients with fall-down OGI showed significantly worse final visual acuity (P < 0.05). Among the types of injury, both the initial and final visual acuity were significantly worse in the rupture group than in the laceration group. Multiple liner regression analyses revealed that the final visual acuity was significantly associated with initial visual acuity, type of injury (rupture), retinal detachment, and proliferative vitreoretinopathy. To predict the visual outcome in patients with OGI, ophthalmologists need to pay attention not only to the initial visual acuity but also to initial ocular conditions, such as the presence of ocular complications.

Clinical characteristics and outcomes of fall-related open globe injuries in Japan.

To investigate the clinical characteristics and visual outcomes in patients with fall-related open globe injuries and to evaluate differences between fall-related and non-fall-related open globe injuries in Japan. A retrospective review of patients with open globe injury who presented to Japan-Clinical Research of Study (J-CREST) hospitals between 2005 and 2015 was enrolled. Clinical information including age, sex, initial visual acuity, final visual acuity, type of injury, status of the crystalline lens, zone of injury, wound length, presence of retinal detachment, proliferative vitreoretinopathy, expulsive hemorrhage, and endophthalmitis was recorded. A total of 374 eyes were enrolled, of which 120 (32.1%) suffered from fall-related injury with average age of 73.7 ± 15.9years (range, 11-101years). A majority of patients were female (55.8%). Of 120 patients with fall-related injury, 109 (90.8%) presented with rupture and 11 (9.2%) with laceration. A multiple regression analysis revealed that final visual acuity was significantly associated with initial visual acuity (r = 0.99, P < 0.001). Compared to non-fall-related open globe injuries, fall-related open globe injuries were associated with elderly age, female sex, poorer initial and final visual acuity, rupture, absence of the lens, larger wound size, retinal detachment, expulsive hemorrhage, and absence of endophthalmitis (P < 0.01). Fall-related open globe injuries were more frequent in elderly female and accompanied by larger wound lengths and severer ocular complications. Visual outcomes in patients with fall-related open globe injuries were related to initial visual acuity.

Population health and regional variations of disease burden in Japan, 1990–2015: a systematic subnational analysis for the Global Burden of Disease Study 2015

SummaryBackgroundJapan has entered the era of super-ageing and advanced health transition, which is increasingly putting pressure on the sustainability of its health system. The level and pace of this health transition might vary across regions within Japan and concern is growing about increasing regional variations in disease burden. The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015) provides a comprehensive, comparable framework. We used data from GBD 2015 with the aim to quantify the burden of disease and injuries, and to attribute risk factors in Japan at a subnational, prefecture-level.MethodsWe used data from GBD 2015 for 315 causes and 79 risk factors of death, disease, and injury incidence and prevalence to measure the burden of diseases and injuries in Japan and in the 47 Japanese prefectures from 1990 to 2015. We extracted data from GBD 2015 to assess mortality, causes of death, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), life expectancy, and healthy life expectancy (HALE) in Japan and its 47 prefectures. We split extracted data by prefecture and applied GBD methods to generate estimates of burden, and attributable burden due to known risk factors. We examined the prefecture-level relationships of common health system inputs (eg, health expenditure and workforces) to the GBD outputs in 2015 to address underlying determinants of regional health variations.FindingsLife expectancy at birth in Japan increased by 4·2 years from 79·0 years (95% uncertainty interval [UI] 79·0 to 79·0) to 83·2 years (83·1 to 83·2) between 1990 and 2015. However, the gaps between prefectures with the lowest and highest life expectancies and HALE have widened, from 2·5 to 3·1 years and from 2·3 to 2·7 years, respectively, from 1990 to 2015. Although overall age-standardised death rates decreased by 29·0% (28·7 to 29·3) from 1990 to 2015, the rates of mortality decline in this period substantially varied across the prefectures, ranging from −32·4% (−34·8 to −30·0) to −22·0% (−20·4 to −20·1). During the same time period, the rate of age-standardised DALYs was reduced overall by 19·8% (17·9 to 22·0). The reduction in rates of age-standardised YLDs was very small by 3·5% (2·6 to 4·3). The pace of reduction in mortality and DALYs in many leading causes has largely levelled off since 2005. Known risk factors accounted for 34·5% (32·4 to 36·9) of DALYs; the two leading behavioural risk factors were unhealthy diets and tobacco smoking in 2015. The common health system inputs were not associated with age-standardised death and DALY rates in 2015.InterpretationJapan has been successful overall in reducing mortality and disability from most major diseases. However, progress has slowed down and health variations between prefectures is growing. In view of the limited association between the prefecture-level health system inputs and health outcomes, the potential sources of regional variations, including subnational health system performance, urgently need assessment.FundingBill & Melinda Gates Foundation, Japan Ministry of Education, Science, Sports and Culture, Japan Ministry of Health, Labour and Welfare, AXA CR Fixed Income Fund and AXA Research Fund.

Time trend analyses of child pedestrian morbidity in Japan

ObjectivesRoad traffic injuries, particularly pedestrian injuries, are a major health issue among children worldwide. The present study quantitatively analyzed the time trends of child pedestrian injuries in Japan from 1975 to 2013 by age. Study designTime trend analysis of nationally aggregated data. MethodsWe analyzed police data on pedestrian injuries requiring medical treatment among children aged 0–15 years occurring between 1975 and 2013. To quantify the time trends of pedestrian injury morbidity rates and to identify change-points in the trends, joinpoint regression analysis was applied by age group. Children were categorized into the age groups of 0–3, 4–6, 7–9, 10–12, and 13–15 years old. ResultsPreschool children aged 0–6 years old showed continuous declining trends throughout the study period; these declining trends accelerated in the 2000s. School-age children aged 7–15 years old showed minimal changes from the early 1970s to the 1990s; of this age group, children aged 7–12 years old showed slight but significant declining trends in the first half and increasing trends in the latter half of this period. Children aged 7–15 years old showed declining trends in the 2000s. Despite the consistent declining trends among all age groups in the 2000s, the younger age groups showed steeper declines during this period. ConclusionsThe declining trends in all age groups in the 2000s may reflect the improved traffic environments in Japan although the environmental approaches are not yet sufficiently adopted yielding modest effects. The continuing contrast between preschool and school-age children may reflect different behaviour changes by age such as more restricted outdoor activities among young children.

Can Ideas From United States Youth Sports Reduce Judo-Related Head Injuries in Japan?

Hiroshi Yokota's article Acute subdural hematoma in judo player with repeated head shines a light on the serious risks of traumatic brain injuries associated with the traditional Japanese sport of judo, and of a relative lack of policies and guidelines for proper handling of concussion in young athletes more generally. The article also highlights the dangers of returning concussed athletes to play prematurely and the risk of second impact syndrome (SIS), a hotly debated diagnosis worldwide. The article, which details a single case, helps demonstrate that protocols in management of concussion and sports related traumatic brain injury (TBI) should not rely on imaging alone, but primarily be based on the athlete's symptoms. Fortunately, sport-specific guidelines have been and are still being developed in the U.S. and around the world. Understanding and implementation of these guidelines, however, is not universal. Good models for hospital-based, state-of-the-art concussion treatment and education centers do exist, and could serve as examples for other entities working to provide communities with better concussion care.Copyright © 2016. Published by Elsevier Inc. Language: en

Self-inflicted injuries are an important cause of penetrating traumatic injuries in Japan.

Japan has a low crime rate, but a high suicide rate. The aim of this study is to review the causes of penetrating traumatic injuries in a tertiary care emergency center in Japan. We retrospectively reviewed all admissions for traumatic injuries over a 3-year period, and calculated the proportion of patients with penetrating traumatic injuries. Weapon used, age, gender, Injury Severity Score, cause of injury, and site of injury in all patients with penetrating injuries were reviewed. The proportion of patients with penetrating injuries among patients with all types of traumatic injuries requiring surgical intervention was calculated. Of 1,321 patients admitted over 3 years, 65 patients (5%) suffered from penetrating injuries. Most were stab wounds, with only one gunshot (2%). The most common site of injury was an extremity (48%). The most common cause of penetrating injury was self-inflicted (38%). The abdomen is the most common site injured among self-inflicted injuries. Of patients with all types of traumatic injuries requiring surgical intervention, penetrating injuries accounted for 23%. Penetrating injuries represent 23% of all patients with traumatic injuries who required surgical intervention. Self-inflicted penetrating injuries were most common, supporting the need for preventive services. Acute care surgeons must be familiar with the surgical management of penetrating traumatic injuries, even in a country with a low crime rate.

Lifestyle risk factors for pressure ulcers in community-based patients with spinal cord injuries in Japan.

Case-control study. To identify daily living-related risk factors for pressure ulcer (PU) occurrence in community-living patients with spinal cord injury (SCI). To determine whether seat pressure influences PU occurrence, and how often patients with SCI perform pressure relief activities while living in the community. Kanagawa Rehabilitation Hospital, Kanagawa, Japan. Thirty-one patients admitted to this hospital for PU treatment were included in the case (PU) group. Thirty outpatients who did not have PUs at the time of the study, and had lived without PUs for at least a year, were included in the control (No PU) group. Patients were interviewed about lifestyle-related PU risk factors and a pressure-mapping system was used to measure interface pressure (IP) on their wheelchair seat. The No PU group patients recorded their daily activities and pressure relief maneuvers for 1 week. Eight lifestyle factors and one risk assessment scale significantly differed between groups. Three factors showed significant odds ratios by logistic regression. IP did not significantly differ between groups. The self-counted number of pressure relief maneuvers (median (25th-75th percentile)) performed per hour in the No PU group was 2.5 (0.7-4.3) and including transfer and urination was 3.5 (2.0-5.3). We identified potential PU risk factors related to lifestyle. The scores of one risk assessment scale were also associated with PU risk. Our results did not suggest an IP damage threshold. Patients in the No PU group performed pressure relief maneuvers, including related activities, approximately once every 17 min.