Epidemiology of severe trauma patients treated by plastic surgeons: A 7-year study at a single regional trauma center in South Korea

Abstract

Background After the laws regulating emergency medicine were amended in 2012, regional trauma centers were established in South Korea. Plastic surgeons specialize in the simultaneous surgical care of patients with facial trauma, burns, and complicated wounds. The objective of this study was to evaluate the role of the plastic surgery department in treating severe trauma patients.Methods From January 2012 to December 2018, we enrolled 366 severe trauma patients with an Injury Severity Score (ISS) over 15 who received treatment by specialists in the plastic surgery department. Of these patients, 298 (81.4%) were male, and their mean age was 51.35 years (range, 6–91 years). The average ISS was 22.01 points (range, 16–75 points).Results The most common diagnosis was facial trauma (95.1%), and facial bone fracture (65.9%) was most common injury within this subgroup. Patients were referred to 1.8 departments on average, with the neurosurgery department accounting for a high proportion of collaborations (37.0%). The most common cause of trauma was traffic accidents (62.3%), and the average length of stay in the general ward and intensive care unit was 36.90 and 8.01 days, respectively. Most patients were discharged home (62.0%) without additional transfer or readmission.Conclusions Through this study, we scoped out the role of the specialty of plastic surgery in the multidisciplinary team at regional trauma centers. These results may have implications for trauma system planning.

A quantitative analysis of trauma patients having undergone plastic surgery

“…In the United States, regardless of socioeconomic background and race, they are the most common cause of death between 1 and 44 years of age, with hundreds of thousands of cases admitted to hospitals each year [ 10 ]. Worldwide, trauma was the cause of 5.8 million deaths in 2012, and the number is expected to post a steady increase [ 7 ]. With the International Red Cross’ approximations of 80 million people being impacted by such occurrences each year, the economic, social and psychological impact is substantial [ 17 ].…”

“…Such is the need for organized efforts to address the burden of traumatic events. In the US, the initial guidance on trauma care set forth by the American College of Surgeons in 1976 served as the foundation for the Level I trauma centers of today [ 7 , 13 , 18 ]. The following years, until the early 2000s, saw “trauma systems” built in every US state [ 18 ].…”

“…The ISS, another anatomical severity index, is calculated using the AIS, which is the sum of the squared top three AIS values. The ISS ranges from 1 to 75 points, and usually divides into groups 1–8 points (minor), 9–15 points (moderate), 16–24 points (serious), 25–49 points (severe), 50–74 points (critical), and 75 points (maximal) [ 7 , 16 ]. Meanwhile, the RTS is a physiological indicator that is highly related to mortality in trauma patients, and its score ranges from 0 to 7.84 points with lower scores representing a poor prognosis.…”

“…Among the AIS subcategories, ‘Head and Neck (H&N)’ and ‘Face’ were investigated. These two subcategories were based on the results of our previous epidemiology study that the plastic surgery treated over 95% of trauma patients with facial injuries [ 7 ].…”

“…Amendment of laws on “emergency medical service act” in 2012 resulted in the government establishing Level I trauma centers (officially referred to as “Regional trauma centers” in South Korea) with the aim of reducing the preventable trauma death rate. Each province now has a regional trauma center, modelled upon the trauma centers of nations with advanced health systems such as the US, all within an hour’s reach of every patient [ 7 ].…”