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 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.

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 Management of severe trauma worldwide: implementation of trauma systems in emerging countries: China, Russia and South Africa

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Jing Zhou ◽  
Tianbing Wang ◽  
Igor Belenkiy ◽  
Timothy Craig Hardcastle ◽  
Jean-Jacques Rouby ◽  
...  
Keyword(s):  
South Africa ◽  
Trauma Care ◽  
Hospital Care ◽  
Life Support ◽  
Trauma Registry ◽  
Trauma System ◽  
Emerging Countries ◽  
Trauma Centers ◽  
Trauma Systems ◽  
National Trauma

AbstractAs emerging countries, China, Russia, and South Africa are establishing and/or improving their trauma systems. China has recently established a trauma system named “the Chinese Regional Trauma Care System” and covered over 200 million populations. It includes paramedic-staffed pre-hospital care, in-hospital care in certified trauma centers, trauma registry, quality assurance, continuous improvement and ongoing coverage of the entire Chinese territory. The Russian trauma system was formed in the first decade of the twenty-first century. Pre-hospital care is region-based, with a regional coordination center that determines which team will go to the scene and the nearest hospital where the victim should be transported. Physician-staffed ambulances are organized according to three levels of trauma severity corresponding to three levels of trauma centers where in-hospital care is managed by a trauma team. No national trauma registry exists in Russia. Improvements to the Russian trauma system have been scheduled. There is no unified trauma system in South Africa, and trauma care is organized by public and private emergency medical service in each province. During the pre-hospital care, paramedics provide basic or advanced life support services and transport the patients to the nearest hospital because of the limited number of trauma centers. In-hospital care is inclusive with a limited number of accredited trauma centers. In-hospital care is managed by emergency medicine with multidisciplinary care by the various specialties. There is no national trauma registry in South Africa. The South African trauma system is facing multiple challenges. An increase in financial support, training for primary emergency trauma care, and coordination of private sector, need to be planned.

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 The impact of regionalized trauma care on the distribution of severely injured patients in the Netherlands

2021 ◽  
Author(s):  
Suzan Dijkink ◽  
Erik W. van Zwet ◽  
Pieta Krijnen ◽  
Luke P. H. Leenen ◽  
Frank W. Bloemers ◽  
...  
Keyword(s):  
The Netherlands ◽  
Trauma Care ◽  
Trauma System ◽  
Future Research ◽  
Severely Injured ◽  
Trauma Centers ◽  
Severely Injured Patients ◽  
The Right ◽  
Injured Patients ◽  
The Impact

Abstract Background Twenty years ago, an inclusive trauma system was implemented in the Netherlands. The goal of this study was to evaluate the impact of structured trauma care on the concentration of severely injured patients over time. Methods All severely injured patients (Injury Severity Score [ISS] ≥ 16) documented in the Dutch Trauma Registry (DTR) in the calendar period 2008–2018 were included for analysis. We compared severely injured patients, with and without severe neurotrauma, directly brought to trauma centers (TC) and non-trauma centers (NTC). The proportion of patients being directly transported to a trauma center was determined, as was the total Abbreviated Injury Score (AIS), and ISS. Results The documented number of severely injured patients increased from 2350 in 2008 to 4694 in 2018. During this period, on average, 70% of these patients were directly admitted to a TC (range 63–74%). Patients without severe neurotrauma had a lower chance of being brought to a TC compared to those with severe neurotrauma. Patients directly presented to a TC were more severely injured, reflected by a higher total AIS and ISS, than those directly transported to a NTC. Conclusion Since the introduction of a well-organized trauma system in the Netherlands, trauma care has become progressively centralized, with more severely injured patients being directly presented to a TC. However, still 30% of these patients is initially brought to a NTC. Future research should focus on improving pre-hospital triage to facilitate swift transfer of the right patient to the right hospital.

scholarly journals Assessing barriers to quality trauma care in low and middle-income countries: A Delphi study

Injury ◽  
2020 ◽  
Vol 51 (2) ◽  
pp. 278-285 ◽  
Author(s):  
J Whitaker ◽  
D Nepogodiev ◽  
A Leather ◽  
J Davies
Keyword(s):  
Trauma Care ◽  
Delphi Study ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

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.

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