Jung Kyoungwon, Kwon Junsik, Huh Yo, Moon Jonghwan, Hwang Kyungjin, Cho Hyun Min, Kim Jae Hun, Park Chan Ik, Yun Jung-Ho, Kim Oh Hyun, Lee Kee-Jae, Kim Sunworl, Lim Borami, Kim Yoon
Department of Surgery, Ajou University School of Medicine, Suwon, South Korea.
Jeju Regional Trauma Center, Cheju Halla General Hospital, Jeju, South Korea.
PLOS Glob Public Health. 2022 Jan 13;2(1):e0000162. doi: 10.1371/journal.pgph.0000162. eCollection 2022.
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.
尽管韩国是一个高收入国家，但其创伤系统却与中低收入国家相当，可预防创伤死亡率超过30%，处于较高水平。自2012年以来，韩国基于区域创伤中心的实施和转运系统的改进建立了国家创伤系统；本研究旨在评估其有效性。我们比较了2015年至2017年期间全国可预防创伤死亡率、转运模式和结果。由多个小组对可预防创伤死亡进行审查，并创建了一个严重程度调整后的逻辑回归模型，以确定影响可预防创伤死亡率的因素。我们还比较了在根据损伤严重程度评分进行调整的模型中，转至急诊医疗机构的创伤患者数量和死亡率。2015年至2017年期间，可预防创伤死亡率有所下降（30.5%对19.9%，p<0.001）。在严重程度调整模型中，2017年可预防创伤死亡风险的优势比低于2015年（0.68，95%置信区间：0.53 - 0.87，p = 0.002）。2017年区域创伤中心接收的严重病例增加了1.6倍（根据国际疾病分类损伤严重程度评分[ICISS]；23.1%对36.5%）。在扩展ICISS模型中，总体创伤死亡率从2.1%（1008/47806）显著降至1.9%（1062/55057）（p = 0.041）。国家创伤系统的建立与创伤护理的绩效和结果的显著改善相关。这主要是由于区域创伤中心的实施，以及更多严重患者被转至区域创伤中心。本研究可能是缺乏创伤系统的中低收入国家的一个良好范例。
