Trauma system establishment and outcome improvement: a retrospective national cohort study in South Korea

被引：14

作者：

Kwon, Junsik ^{[1
,2
]}

Lee, Myeonggyun ^{[6
]}

Kim, Yoon ^{[3
]}

Moon, Jonghwan ^{[1
,2
]}

Huh, Yo ^{[1
,2
]}

Song, Seoyoung ^{[2
]}

Kim, Sora ^{[2
]}

Ko, Jung-in ^{[4
,5
]}

Jung, Kyoungwon ^{[1
,2
]}

机构：

[1] Ajou Univ, Dept Surg, Div Trauma Surg, Sch Med, 164 World Cup Ro, Suwon 16499, South Korea

[2] Ajou Univ Hosp, Gyeonggi South Reg Trauma Ctr, Suwon, South Korea

[3] Seoul Natl Univ, Dept Hlth Policy & Management, Coll Med, Seoul, South Korea

[4] Natl Med Ctr, Natl Emergency Med Ctr, Dept Emergency Med, Seoul, South Korea

[5] Natl Med Ctr, Natl Emergency Med Ctr, Seoul, South Korea

[6] NYU, Dept Populat Hlth, Div Biostat, Grossman Sch Med, New York, NY USA

来源：

INTERNATIONAL JOURNAL OF SURGERY | 2023年 / 109卷 / 08期

关键词：

mortality; outcome; performance; trauma center; trauma system; wounds and injuries; INCLUSIVE TRAUMA; INJURY OUTCOMES; IMPACT; DEATH; CARE;

D O I：

10.1097/JS9.0000000000000481

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

Background:Trauma is a major cause of mortality, disability, and health care costs worldwide. The establishment of a trauma system is known to solve these problems, but few studies have objectively evaluated the impact of a trauma system on outcomes. Since 2012, South Korea has established a national trauma system based on the implementation of 17 regional trauma centers nationwide and the improvement of the prehospital transfer system. This study aimed to measure the changes in performance and outcome according to the established national trauma system. Material and Methods:In this national cohort-based, retrospective follow-up observational study, the authors calculated the preventable trauma death rate (PTDR) by conducting a multipanel review of patients who died in 2015, 2017, and 2019. Furthermore, the authors constructed a risk-adjusted mortality prediction model of 4 767 876 patients between 2015 and 2019 using the extended-International Classification of Disease Injury Severity Scores to compare outcomes. Results:The PTDR was lower in 2019 than in 2015 (15.7 vs. 30.5, P <0.001) and 2017 (15.7 vs. 19.9%, P<0.001) representing 1247 additional lives saved in 2019 compared to that in 2015. In the risk-adjusted model, total trauma mortality was highest in 2015 at 0.56%, followed by that in 2016 and 2017 (0.50%), 2018 (0.51%), and 2019 (0.48%), revealing a significant decrease in mortality over the years (P<0.001 for trend), representing nearly 800 additional lives saved. The number of deaths for more severe patients with a probability of survival less than 0.25 significantly decreased from 81.50% in 2015 to 66.17% in 2019 (P<0.001). Conclusions:The authors observed a significant reduction in the PTDR and risk-adjusted trauma mortality in the 5-year follow-up since 2015 when the national trauma system was established. These findings could serve as a model for low-income and middle-income countries, where trauma systems are not yet established.

引用

页码：2293 / 2302

页数：10

共 45 条

[1]

Abbafati C, 2020, LANCET, V396, P1204

[2]

Afuwape O O, 2011, West Afr J Med, V30, P19

[3]

[Anonymous], 2014, Resources for optimal care of the injured patient

[4] A Population-Based Survival Assessment of Categorizing Level III and IV Rural Hospitals as Trauma Centers [J].