National trauma system establishment based on implementation of regional trauma centers improves outcomes of trauma care: A follow-up observational study in South Korea

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.

Effects of Transport to Trauma Centers on Survival Outcomes Among Severe Trauma Patients in Korea: Nationwide Age-Stratified Analysis

“…The effectiveness of transport to trauma center was well-known from previous studies, 4 5 and studies in Korea have also shown that transport to trauma center can make better outcomes. 30 31 32 However, our study suggested that the transportation to the trauma center after severe trauma may not be significantly effective for pediatric populations. It is well validated that pediatric trauma centers improved clinical and functional outcomes for pediatric patients with traumatic injuries.…”

Does the Probability of Survival Calculated by the Trauma and Injury Severity Score Method Accurately Reflect the Severity of Neurotrauma Patients Admitted to Regional Trauma Centers in Korea?

“…Despite the lack of a solid foundation for trauma and injury research in the country, a few researchers have introduced and analyzed assessment tools such as AIS, ISS, RTS, and TRISS. 1 7 8 9 10 11 The establishment of the first RTC in Korea in 2004 marked a significant milestone, and the foundation for trauma research and care has gradually improved over the past decade. As the trauma center system reaches maturity, it is essential to analyze optimized datasets to improve the quality of care and assess the suitability of evaluation tools.…”

Trends of Blood Transfusion According to Diseases in Korea: A 10-Year Nationwide Cohort Study

“…This may be because the overall incidence of GI cancer has been decreasing with an increase in screening tests [ 12 , 13 ]. In trauma, the blood transfusion rate is increasing, which is thought to be due to the establishment and systematization of trauma centers in Korea and active treatment for trauma patients [ 14 ]. In addition, the number of blood transfusions in hematologic diseases is increasing, which is thought to be due to the development of treatment, as well as the increased incidence [ 15 , 16 ].…”