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

2022 ◽  
Vol 2 (1) ◽  
pp. e0000162
Author(s):  
Kyoungwon Jung ◽  
Junsik Kwon ◽  
Yo Huh ◽  
Jonghwan Moon ◽  
Kyungjin Hwang ◽  
...  
Keyword(s):  
South Korea ◽  
Death Rate ◽  
Injury Severity ◽  
Trauma System ◽  
Trauma Centers ◽  
Middle Income ◽  
Death Rates ◽  
Middle Income Countries ◽  
National Trauma ◽  
Trauma Death

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.

scholarly journals National Trauma System Establishment Based on Implementation of Regional Trauma Centers Improves Outcomes of Trauma Care; A Follow-up Observational Study in South Korea

2021 ◽  
Author(s):  
Kyoungwon Jung ◽  
Junsik Kwon ◽  
Yo Huh ◽  
Jonghwan Moon ◽  
Kyungjin Hwang ◽  
...  
Keyword(s):  
Trauma Care ◽  
Death Rate ◽  
Injury Severity ◽  
Trauma System ◽  
Trauma Centers ◽  
Middle Income ◽  
Death Rates ◽  
Middle Income Countries ◽  
National Trauma ◽  
Trauma Death

Abstract Background: Although Korea is a high-income country, its trauma system is comparable to low- and middle-income countries with high preventable trauma death rates (> 30%). Since 2012, 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.Methods: 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.Results: 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% (1008/47806) to 1.9% (1062/55057) (p = 0.041).Conclusions: Establishment of the national trauma system was associated with significant improvements in 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.

scholarly journals Preventable Trauma Death Rate after Establishing a National Trauma System in Korea

2019 ◽  
Vol 34 (8) ◽  
Author(s):  
Kyoungwon Jung ◽  
Ikhan Kim ◽  
Sue K. Park ◽  
Hyunmin Cho ◽  
Chan Yong Park ◽  
...  
Keyword(s):  
Death Rate ◽  
Trauma System ◽  
National Trauma ◽  
Trauma Death

scholarly journals Performance of injury severity measures in trauma research: a literature review and validation analysis of studies from low-income and middle-income countries

BMJ Open ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. e023161 ◽  
Author(s):  
Amber Mehmood ◽  
Yuen W Hung ◽  
Huan He ◽  
Shahmir Ali ◽  
Abdul M Bachani
Keyword(s):  
Hospital Mortality ◽  
Injury Severity Score ◽  
Low Income ◽  
Severity Score ◽  
Validation Studies ◽  
Injury Severity ◽  
Middle Income ◽  
War Injuries ◽  
Trauma Research ◽  
Middle Income Countries

IntroductionCharacterisation of injury severity is an important pillar of scientific research to measure and compare the outcomes. Although majority of injury severity measures were developed in high-income countries, many have been studied in low-income and middle-income countries (LMICs). We conducted this study to identify and characterise all injury severity measures, describe how widely and frequently they are used in trauma research from LMICs, and summarise the evidence on their performance based on empirical and theoretical validation​ analysis.MethodsFirst, a list of injury measures was identified through PubMed search. Subsequently, a systematic search of PubMed, Global Health and EMBASE was undertaken on LMIC trauma literature published from January 2006 to June 2016, in order to assess the application and performance of injury severity measures to predict in-hospital mortality. Studies that applied one or more global injury severity measure(s) on all types of injuries were included, with the exception of war injuries and isolated organ injuries.ResultsOver a span of 40 years, more than 55 injury severity measures were developed. Out of 3862 non-duplicate citations, 597 studies from 54 LMICs were listed as eligible studies. Full-text review revealed 37 studies describing performance of injury severity measures for outcome prediction. Twenty-five articles from 13 LMICs assessed the validity of at least one injury severity measure for in-hospital mortality. Injury severity score was the most commonly validated measure in LMICs, with a wide range of performance (area under the receiver operating characteristic curve (AUROC) between 0.9 and 0.65). Trauma and Injury Severity Score validation studies reported AUROC between 0.80 and 0.98.ConclusionEmpirical studies from LMICs frequently use injury severity measures, however, no single injury severity measure has shown a consistent result in all settings or populations and thus warrants validation studies for the diversity of LMIC population.

Is Outcome after Blunt Splenic Injury in Adults Better in High-Volume Trauma Centers?

2005 ◽  
Vol 71 (11) ◽  
pp. 942-949 ◽  
Author(s):  
Brian G. Harbrecht ◽  
Mazen S. Zenati ◽  
Louis H. Alarcon ◽  
Juan B. Ochoa ◽  
Juan C. Puyana ◽  
...  
Keyword(s):  
Emergency Department ◽  
Trauma Center ◽  
Injury Severity ◽  
Trauma System ◽  
High Volume ◽  
Trauma Centers ◽  
Case Volume ◽  
Center Volume ◽  
Low Volume ◽  
Outcome Differences

An association between outcome and case volume has been demonstrated for selected complex operations. The relationship between trauma center volume and patient outcome has also been examined, but no clear consensus has been established. The American College of Surgeons (ACS) has published recommendations on optimal trauma center volume for level 1 designation. We examined whether this volume criteria was associated with outcome differences for the treatment of adult blunt splenic injuries. Using a state trauma database, ACS criteria were used to stratify trauma centers into high-volume centers (>240 patients with Injury Severity Score >15 per year) or low-volume centers, and outcome was evaluated. There were 1,829 patients treated at high-volume centers and 1,040 patients treated at low-volume centers. There was no difference in age, gender, emergency department pulse, emergency department systolic blood pressure, or overall mortality between high- and low-volume centers. Patients at low-volume centers were more likely to be treated operatively, but the overall success rate of nonoperative management between high-and low-volume centers was similar. These data suggest that ACS criteria for trauma centers level designation are not associated with differences in outcome in the treatment of adult blunt splenic injuries in this regional trauma system.

High-Performance Trauma Centers in a Single-State Trauma System

2020 ◽  
Vol 86 (7) ◽  
pp. 766-772
Author(s):  
Justin S. Hatchimonji ◽  
Elinore J. Kaufman ◽  
Andrew J. Young ◽  
Brian P. Smith ◽  
Ruiying Xiong ◽  
...  
Keyword(s):  
Mortality Risk ◽  
High Performance ◽  
Injury Severity ◽  
Trauma System ◽  
Trauma Centers ◽  
High Performing ◽  
Patient Level ◽  
High Performer ◽  
Chi Squared ◽  
Expected Mortality

Background Trauma centers with low observed:expected (O:E) mortality ratios are considered high performers; however, it is unknown whether improvements in this ratio are due to a small number of unexpected survivors with high mortality risk (big saves) or a larger number of unexpected survivors with moderate mortality risk (marginal gains). We hypothesized that the highest-performing centers achieve that status via larger numbers of unexpected survivors with moderate mortality risk. Methods We calculated O:E ratios for trauma centers in Pennsylvania for 2016 using a risk-adjusted mortality model. We identified high and low performers as centers whose 95% CIs did not cross 1. We visualized differences between these centers by plotting patient-level observed and expected mortality; we then examined differences in a subset of patients with a predicted mortality of ≥10% using the chi-squared test. Results One high performer and 1 low performer were identified. The high performer managed a population with more blunt injuries (97.2% vs 93.6%, P < .001) and a higher median Injury Severity Score (14 vs 11, P < .001). There was no difference in survival between these centers in patients with an expected mortality of <10% (98.0% vs 96.7%, P = .11) or ≥70% (23.5% vs 10.8%, P = .22), but there was a difference in the subset with an expected mortality of ≥10% (77.5% vs 43.1%, P < .001). Conclusions Though patients with very low predicted mortality do equally well in high-performing and low-performing centers, the fact that performance seems determined by outcomes of patients with moderate predicted mortality favors a “marginal gains” theory.

Association of traumatic brain injury severity and time to definitive care in three low-middle-income European countries

2021 ◽  
pp. injuryprev-2020-044049
Author(s):  
Corinne Peek-Asa ◽  
Madalina Adina Coman ◽  
Alison Zorn ◽  
Nino Chikhladze ◽  
Serghei Cebanu ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Injury Severity ◽  
Road Traffic ◽  
Severe Injury ◽  
Severe Injuries ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low Middle Income Countries ◽  
Traumatic Brain Injury Severity

BackgroundLow-middle-income countries experience among the highest rates of traumatic brain injury in the world. Much of this burden may be preventable with faster intervention, including reducing the time to definitive care. This study examines the relationship between traumatic brain injury severity and time to definitive care in major trauma hospitals in three low-middle-income countries.MethodsA prospective traumatic brain injury registry was implemented in six trauma hospitals in Armenia, Georgia and the Republic of Moldova for 6 months in 2019. Brain injury severity was measured using the Glasgow Coma Scale (GCS) at admission. Time to definitive care was the time from injury until arrival at the hospital. Cox proportionate hazards models predicted time to care by severity, controlling for age, sex, mechanism, mode of transportation, location of injury and country.ResultsAmong 1135 patients, 749 (66.0%) were paediatric and 386 (34.0%) were adults. Falls and road traffic were the most common mechanisms. A higher proportion of adult (23.6%) than paediatric (5.4%) patients had GCS scores indicating moderate (GCS 9–11) or severe injury (GCS 0–8) (p<0.001). Less severe injury was associated with shorter times to care, while more severe injury was associated with longer times to care (HR=1.05, 95% CI 1.01 to 1.09). Age interacted with time to care, with paediatric cases receiving faster care.ConclusionsImplementation of standard triage and transport protocols may reduce mortality and improve outcomes from traumatic brain injury, and trauma systems should focus on the most severe injuries.

Trauma system development in low- and middle-income countries: a review

2015 ◽  
Vol 193 (1) ◽  
pp. 300-307 ◽  
Author(s):  
Tyler E. Callese ◽  
Christopher T. Richards ◽  
Pamela Shaw ◽  
Steven J. Schuetz ◽  
Lorenzo Paladino ◽  
...  
Keyword(s):  
System Development ◽  
Trauma System ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

Are All Level I Trauma Centers Created Equal? A Comparison of American College of Surgeons and State-Verified Centers

2011 ◽  
Vol 77 (10) ◽  
pp. 1334-1336 ◽  
Author(s):  
Jennifer Smith ◽  
David Plurad ◽  
Kenji Inaba ◽  
Peep Talving ◽  
Lydia Lam ◽  
...  
Keyword(s):  
Injury Severity ◽  
Distress Syndrome ◽  
Data Bank ◽  
Trauma Centers ◽  
National Trauma ◽  
National Trauma Data Bank ◽  
American College Of Surgeons ◽  
Outcome Differences ◽  
Level I ◽  
Facility Size

Scant literature investigates potential outcome differences between Level I trauma centers. We compared overall survival and survival after acute respiratory distress syndrome (ARDS) in patients admitted to American College of Surgeons (ACS)-verified versus state-verified Level I trauma centers. Using the National Trauma Data Bank Version 7.0, incident codes associated with admission to an ACS-verified facility were extracted and compared with the group admitted to state-verified centers. Overall, there were 382,801 (73.7%) patients admitted to ACS and 136,601 (26.3%) admitted to state centers. There was no adjusted survival advantage after admission to either type (4.9% for ACS vs 4.8% for state centers; 1.014 [95% CI, 0.987 to 1.042], P = 0.311). However, in the 3,088 cases of ARDS, mortality for admission to the ACS centers was 20.3 per cent (451 of 2,220) versus 27.1 per cent (235 of 868) for state centers. Adjusting for injury severity and facility size, admission to an ACS center was associated with a significantly greater survival after ARDS (0.75 [0.654 to 0.860]; P < 0.001). Level I verification does not necessarily imply similar outcomes in all subgroups. Federal oversight may become necessary to ensure uniformity of care, maximizing outcomes across all United States trauma systems. Further study is needed.

A Decade Evaluation of a State Trauma System: Has Access to Inpatient Trauma Care at Designated Trauma Centers Improved?

2017 ◽  
Vol 83 (7) ◽  
pp. 769-777 ◽  
Author(s):  
◽  
Dennis W. Ashley ◽  
Etienne E. Pracht ◽  
Regina S. Medeiros ◽  
Elizabeth V. Atkins ◽  
...  
Keyword(s):  
Trauma Care ◽  
Injury Severity ◽  
Trauma System ◽  
Age Groups ◽  
Trauma Centers ◽  
Access To Treatment ◽  
Score Method ◽  
Severity Levels ◽  
Injured Patients ◽  
Discharge Database

Recently, the trauma center component of the Georgia trauma system was evaluated demonstrating a 10 per cent probability of increased survival for severely injured patients treated at designated trauma centers (DTCs) versus nontrauma centers. The purpose of this study was to determine the effectiveness of a state trauma system to provide access to inpatient trauma care at DTCs for its residents. We reviewed 371,786 patients from the state's discharge database and identified 255,657 treated at either a DTC or a nontrauma center between 2003 and 2012. Injury severity was assigned using the International Classification Injury Severity Score method. Injury was categorized as mild, moderate, or severe. Patients were also categorized by age and injury type. Access improved over time in all severity levels, age groups, and injury types. Although elderly had the largest improvement in access, still only 70 per cent were treated at a DTC. During the study period, increases were noted for all age groups, injury severity levels, and types of injury. A closer examination of the injured elderly population is needed to determine the cause of lower utilization by this age group. Overall, the state's trauma system continues to mature by providing patients with increased access to treatment at DTCs.

scholarly journals Differences by country-level income in COVID-19 cases, deaths, case-fatality rates, and rates per million population in the first five months of the pandemic

2020 ◽  
Author(s):  
Wrishmeen Sabawoon
Keyword(s):  
Low Income ◽  
Case Fatality Rate ◽  
Case Fatality ◽  
Incidence Rates ◽  
High Income ◽  
Fatality Rate ◽  
Middle Income ◽  
Death Rates ◽  
Middle Income Countries ◽  
Country Level

Abstract Objective: To describe differences by country-level income in COVID-19 cases, deaths, case-fatality rates, incidence rates, and death rates per million population. Methods: Publicly available data on COVID-19 cases and deaths from December 31, 2019 to June 3, 2020 were analyzed. Kruskal-Wallis tests were used to examine associations of country-level income with COVID-19 cases, deaths, case-fatality rates, incidence rates, and death rates. Results: A total of 380,803 deaths out of 6,348,204 COVID-19 cases were reported from 210 countries and territories globally in the period under study, and the global case-fatality rate was 6.0%. Of the total globally reported cases and deaths, the percentages of cases and deaths were 59.9% and 75.0% for high-income countries, and 30.9% and 20.7% for upper-middle-income countries. Countries in higher-income categories had higher incidence rates and death rates. Between April and May, the incidence rates in higher-income groups of countries decreased, but in other groups, it increased. Conclusions In the first five months of the COVID-19 pandemic, most cases and deaths were reported from high-income and upper-middle-income countries, and those countries had higher incidence rates and death rates per million population than did lower-middle and low-income countries. Keywords: COVID-19, incidence rate, death rate, case fatality rate, income, and country

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