Mortality Reduction in Major Trauma Patients after Establishment of a Level I Trauma Center in Korea: A Single-Center Experience

Abstract

Purpose: Trauma systems have been shown to decrease injury-related mortality. The present study aimed to compare the mortality rates of patients with major trauma (injury severity score >15) treated before and after the establishment of a level I trauma center. Methods: During this 20-month study, participants were divided into pre-trauma center and trauma center groups, and trauma and injury severity score (TRISS) method was used to compare mortality rates during 10-month periods before and after the establishment of the trauma center (October 2013 to July 2014 vs. October 2014 to July 2015). Results: Of the 541 total participants, 278 (51.5%) visited after the establishment of the trauma center. The Z and W statistics indicated better outcomes in the trauma center group than in the pre-trauma center group (Z statistic, 2.635 vs. -0.700; W statistic, 4.640). The trauma center group also exhibited meaningful reductions in the time interval from the emergency department (ED) visit to emergency surgery (118.0 minutes vs. 142.5 minutes, p=0.020) and the interval from the ED visit to intensive care unit admission (202.0 minutes vs. 259.0 minutes, p=0.035) relative to the pre-trauma center group. Conclusions: The TRISS and multivariate analysis revealed significant improvements in survival rates in the trauma center group, compared to the pre-trauma center group.

Survival benefit of direct transport to trauma centers among patients with unintentional injuries in Korea: a propensity score-matched analysis

“…In a past clinical analysis of patients with severe trauma, shortening the time from trauma to appropriate treatment was associated with reduced mortality. 15 Patients with severe trauma may not be able to quickly receive high-quality care when they are transported to non-TCs. Repeated interfacility transfer of patients and imaging may affect prognosis.…”

Intentionally self-injured patients have lower mortality when treated at trauma centers versus non-trauma centers in South Korea

“…Repetitive interfacility transfers and imaging examinations may also affect patient prognosis. 14–16 In Korea, patients with severe trauma are transferred to TC and non-TC facilities without clear guidelines. 17 Although TC transfer improves survival rates in patients with unintentional severe trauma, patients of intentional injury have not been investigated.…”

Mortality Trends in Chest-Abdominal Trauma Patients Before and After the Establishment of Trauma Centers in South Korea

“…Two national reports in 2012 [2] and 2019 [6] have documented decreases in the preventable death rate for trauma and a drop from 30.5% to 21.9% was reported [6], which is likely due to improvements in medical treatment and medical facilities dedicated to trauma in South Korea. Actually, several reports in the Republic of Korea reported that the quality of medical treatment had improved after the operation of trauma centers [22][23][24]. In addition, a reduction in preventable death rates combined overall mortalities decreased with the operation of trauma centers [3][4][5].…”

“…Although we would not confirm the severity of trauma and transfer status of patients accurately in this study because the claims database did not have enough information. Nevertheless, compared with other emergency medical institutions, trauma centers specializing in treating trauma patients have been reported to show lower preventable death rates (trauma center 21.9%; emergency medical institution, 33.9%; OR 2.13), and Z and W scores (Z score; it indicates the statistical significance of the difference between the number of actual versus expected survivors, W score; It describes the number of unexpected survival outcome per 100 patients) have reportedly risen after the opening of regional trauma centers [3,22,24]. Caring for the majority of severe trauma patients in the trauma center facilitates an increase in the survival rate of severe trauma patients which was the purpose of establishing the trauma center.…”