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

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.

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

PLOS Global Public Health ◽

10.1371/journal.pgph.0000162 ◽

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.

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Systematic Preventable Trauma Death Rate Survey to Establish the Region-based Inclusive Trauma System in a Representative Province of Korea

Journal of Korean Medical Science ◽

10.3346/jkms.2020.35.e417 ◽

2020 ◽

Vol 35 (50) ◽

Author(s):

Junsik Kwon ◽

Jin-Hee Lee ◽

Kyungjin Hwang ◽

Yunjung Heo ◽

Hang Joo Cho ◽

...

Keyword(s):

Death Rate ◽

Trauma System ◽

Trauma Death

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PARK Index for Preventable Major Trauma Death Rate

Journal of Trauma and Injury ◽

10.20408/jti.2015.28.3.115 ◽

2015 ◽

Vol 28 (3) ◽

pp. 115-122 ◽

Cited By ~ 1

Author(s):

Chan Yong Park ◽

Byungchul Yu ◽

Ho Hyun Kim ◽

Jung Joo Hwang ◽

Jungnam Lee ◽

...

Keyword(s):

Death Rate ◽

Major Trauma ◽

Trauma Death

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Preventable trauma death rate in Daegu, South Korea

Clinical and Experimental Emergency Medicine ◽

10.15441/ceem.15.085 ◽

2015 ◽

Vol 2 (4) ◽

pp. 236-243 ◽

Cited By ~ 4

Author(s):

Sungbae Moon ◽

Suk Hee Lee ◽

Hyun Wook Ryoo ◽

Jong Kun Kim ◽

Jae Yun Ahn ◽

...

Keyword(s):

South Korea ◽

Death Rate ◽

Trauma Death

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

Critical Care ◽

10.1186/s13054-021-03681-8 ◽

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.

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Trauma Specialist Centres

Bulletin of The Royal College of Surgeons of England ◽

10.1308/147363507x216681 ◽

2007 ◽

Vol 89 (7) ◽

pp. 252-253 ◽

Cited By ~ 3

Author(s):

Karim Brohi

Keyword(s):

Trauma Care ◽

Trauma System ◽

England And Wales ◽

National Trauma ◽

Trauma Service ◽

Specialist Centre ◽

Injured Patients ◽

First Time

In 2011 it will be 50 years since the Osmond-Clarke report first proposed a network of specialist units to care for injured patients across England and Wales. Since that time there have been multiple aborted attempts to implement regionalisation of trauma care. For the first time in half a century the clinical imperative now appears to be supported by a political recognition of the importance of a national trauma system to UK citizens. With this in mind, this paper aims to describe the role of a trauma specialist centre within its regional trauma system; the capabilities, resources and infrastructure required; and the functions of a specialist trauma service.

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Disaster Preparedness Should Represent an Augmentation of the Everyday Trauma System – But Are We Prepared?

10.21203/rs.3.rs-84135/v1 ◽

2020 ◽

Author(s):

Jørgen Joakim Jørgensen ◽

Peter Wiel Monrad-Hansen ◽

Christine Gaarder ◽

Pål Aksel Næss

Keyword(s):

Disaster Preparedness ◽

Trauma System ◽

Working Hours ◽

Trauma Team ◽

Trauma Centers ◽

Team Members ◽

National Trauma ◽

The Everyday ◽

Holiday Season ◽

System Requirements

Abstract IntroductionMass casualty incidents (MCI) range from natural disasters to terrorist attacks. The increased frequency, geographical spread and the heterogenicity in type of terror incidents, challenge healthcare systems all over the world. Trauma systems constitute the base upon which disaster preparedness is being build. The largest MCI in Norway took place 22 July 2011 and several lessons were learnt including the importance of having designed the everyday trauma infrastructure to be able to increase activity and adjust according to needs. Norway is sparsely populated, with a national trauma system consisting of four regional trauma centers (TCs) and 35 acute care hospitals treating trauma (non-trauma centers; NTCs) We wanted to assess how well hospitals fill the national trauma system requirements for competence, and the degree of awareness of existing MCI plans.MethodsWe conducted a cross-sectional survey of the on-call trauma team in all 39 Norwegian hospitals during two time periods: July-August (HS; holiday season) and September – June (NHS; non-holiday season). A standardized questionnaire was used to evaluate the MCI preparedness.ResultsA total of 347 trauma team members participated with 173 during HS and 174 during NHS. Over 95% of the team members were aware of the hospital MCI plan, only half had read the plan during the last 6 months, whereas 63% at the TCs and 74% at NTCs were confident with their designated role in the event of an MCI. Trauma team exercises were conducted regularly and 86% had ever participated, primarily residents and nurses. Only 63% at the TCs and 53% at the NTCs had participated in an MCI exercise. The proportion of resident surgeons and anesthetists with >4 years clinical experience was significantly higher in TCs (88% and 63%) than in NTCs (27% and 17%). At NTCs 38% of the resident surgeons were on call from home after working hours. All the on-call consultant surgeons were at home after working hours, leaving interns in charge at several of the hospitals. All resident surgeons at the TCs were ATLS providers compared to 64% at the NTCs and almost 90% of the consultant surgeons had participated in advanced trauma surgical courses. ConclusionDespite increased focus on disaster preparedness at a national level after the 2011 attacks, we identified limited compliance with trauma system requirements concerning competency and training. Strict guidelines to secure immediate notification and early presence of consultants whenever a situation that might turn into an MCI occurs should be a prerequisite. The awareness and content of existing MCI plans should be continuously improved to be able to meet the challenges of future MCIs.

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Evaluating trauma care, outcomes and costs in a system in crisis: the necessity of a Greek National Trauma Database

Trauma Surgery & Acute Care Open ◽

10.1136/tsaco-2019-000401 ◽

2020 ◽

Vol 5 (1) ◽

pp. e000401

Author(s):

Apostolos Prionas ◽

George Tsoulfas ◽

Andreas Tooulias ◽

Apostolos Papakoulas ◽

Athanasios Piachas ◽

...

Keyword(s):

Financial Burden ◽

Trauma System ◽

National Database ◽

Trauma Patients ◽

Trauma Management ◽

National Trauma ◽

Field Triage ◽

The Us ◽

Prehospital Triage ◽

Triage Algorithm

BackgroundAt present there is no organized trauma system in Greece and no national trauma database. The objective of this study was to record and evaluate trauma management at our university hospital and to measure the associated healthcare costs, while laying the foundations for a national database and the organization of regional trauma networks.MethodsRetrospective study of trauma patients (n=2320) between 2014 and 2015, through our single-center registry. Demographic information, injury patterns, hospital transfer, investigations, interventions, duration of hospitalization, Injury Severity Score (ISS), outcomes, complications and cost were recorded.ResultsRoad traffic collisions (RTC) accounted for 23.2% of traumas. The proportion of patients who were transferred to the hospital by the National Emergency Medical Services decreased throughout the study (n2015=76/1192 (6.38%), n2014=109/1128 (9.7%)) (p<0.05). 1209 (52.1%) of our trauma patients did not meet the US trauma field triage algorithm criteria. Overtriage of trauma patients to our facility ranged from 90.7% to 96.7%, depending on the criteria used (clinical vs. ISS criteria). Ninety-one (3.9%) of our patients received operative management. Intensive care unit admissions were 21 (0.1%). Seventy-six (3.3%) of our patients had ISS>15 and their mortality was 31.6%. The overall non-salary cost for trauma management was €623 140. 53% of these costs were attributed to RTCs. The cost resulting from the observed overtriage ranged from €121 000 to €315 000. Patients who did not meet the US trauma triage algorithm criteria accounted for 10.5% of total expenses.DiscussionOur results suggest that RTCs pose a significant financial burden. The prehospital triage of trauma patients is ineffective. A reduction of costs could have been achieved if prehospital triage was more effective.Level of evidenceLevel IV.

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Development and pilot implementation of a standardised trauma documentation form to inform a national trauma registry in a low-resource setting: lessons from Tanzania

BMJ Open ◽

10.1136/bmjopen-2020-038022 ◽

2020 ◽

Vol 10 (10) ◽

pp. e038022

Author(s):

Hendry R Sawe ◽

Teri A Reynolds ◽

Ellen J Weber ◽

Juma A Mfinanga ◽

Timothy J Coats ◽

...

Keyword(s):

Trauma Registry ◽

Trauma System ◽

Healthcare Providers ◽

Sub Saharan Africa ◽

Trauma Patients ◽

Structured Interviews ◽

Data Set ◽

National Trauma ◽

Resource Setting ◽

Documentation Form

ObjectivesTrauma registries are an integral part of a well-organised trauma system. Tanzania, like many low and middle-income countries, does not have a trauma registry. We describe the development, structure, implementation and impact of a context appropriate standardised trauma form based on the adaptation of the WHO Data Set for Injury (DSI), for clinical documentation and use in a national trauma registry.SettingOur study was conducted in emergency units of five regional referral hospitals in Tanzania.ProceduresMixed methods participatory action research was employed. After an assessment of baseline trauma documentation, we conducted semi-structured interviews with a purposefully selected sample of 33 healthcare providers from all participating hospitals to understand, develop, pilot and implement a standardised trauma form. We compared the number and types of variables captured before and after the form was implemented.OutcomesChange in proportion of variables of DSI captured after implementation of a standardised trauma documentation form.ResultsPiloting and feedback informed the development of a context appropriate standardised trauma documentation paper form with carbonless copy that could be used as both the clinical chart and data capture. Among 721 patients (seen by 21 clinicians) during the initial 30-day pilot, overall variable capture was 86.4% of required variables. After modifications of the form and training of healthcare providers, the form was implemented for 7 months, during which the capture improved to 96.3% among 6302 patients (seen by 31 clinicians). The providers reported the form was user-friendly, resulted in less time documenting, and served as a guide to managing trauma patients.ConclusionsThe development and implementation of a contextually appropriate, standardised trauma form were successful, yielding increased capture rates of injury variables. This system will facilitate expansion of the trauma registry across the country and inform similar initiatives in Sub-Saharan Africa.

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