Abstract
Although South Korea is a high-income country, its trauma system is comparable to low- and middle-income countries with high preventable trauma death rates of more than 30%. Since 2012, South Korea has established a national trauma system based on the implementation of regional trauma centers and improvement of the transfer system; this study aimed to evaluate its effectiveness. We compared the national preventable trauma death rates, transfer patterns, and outcomes between 2015 and 2017. The review of preventable trauma deaths was conducted by multiple panels, and a severity-adjusted logistic regression model was created to identify factors influencing the preventable trauma death rate. We also compared the number of trauma patients transferred to emergency medical institutions and mortality in models adjusted with injury severity scores. The preventable trauma death rate decreased from 2015 to 2017 (30.5% vs. 19.9%, p < 0.001). In the severity-adjusted model, the preventable trauma death risk had a lower odds ratio (0.68, 95% confidence interval: 0.53-0.87, p = 0.002) in 2017 than in 2015. Regional trauma centers received 1.6 times more severe cases in 2017 (according to the International Classification of Diseases Injury Severity Score [ICISS]; 23.1% vs. 36.5%). In the extended ICISS model, the overall trauma mortality decreased significantly from 2.1% (1008/47 806) to 1.9% (1062/55 057) (p = 0.041). The establishment of the national trauma system was associated with significant improvements in the performance and outcomes of trauma care. This was mainly because of the implementation of regional trauma centers and because more severe patients were transferred to regional trauma centers. This study might be a good model for low- and middle-income countries, which lack a trauma system.
Highlights
Injury, the leading cause of death in the reproductive-age group individuals < 40 years, is a major public health problem [1,2,3]
The preventable trauma death rate (PTDR) significantly decreased in all regions except Region I, where there was a minimal change from 30.8% in 2015 to 30.2% in 2017 (Table 1, Fig 3B)
Regarding emergency medical institutions (EMIs) that were the destinations of hospitalization, the Local Emergency Medical Center (LEMC) and Local Emergency Medical Institution (LEMI) presented significantly lower PTDRs in 2017
Summary
The leading cause of death in the reproductive-age group individuals < 40 years, is a major public health problem [1,2,3]. Each year, 10% of all deaths are due to injury, and many more are disabled [3, 4]. The burden is especially high in low- and middle-income countries (LMICs) because more than 90% of injury-related deaths occur in LMICs [6]. Remarkable reductions in injury-related mortality, disability, and costs have been achieved in many healthcare jurisdictions by introducing trauma systems [7,8,9,10,11,12]; well-organized trauma systems have only been minimally implemented in most LMICs [4]. Few examples of the establishment of national trauma systems that started in LMICs, such as African or Asian countries, have been reported; these trauma systems are still in their infancy, not systematic, and do not provide high-quality evidence [21,22,23]. Few studies have been conducted to follow up, serially and prospectively, the effect of a national trauma system (NTS) for all emergency medical institutions (EMIs) across the country
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