BACKGROUND:The preventable trauma death rate (PTDR) is a key measure of trauma system performance. This study, the fourth follow-up since the implementation of trauma centers in South Korea, aimed to evaluate trends in PTDR and assess the mid-term performance of the trauma system. The study utilized consistent methods with previous analyses to ensure comparability and continuity. METHODS:A total of 8,490 trauma deaths occurred in 2021, and 1,688 patients from 265 medical institutions were included in the study. A multidisciplinary panel review was conducted to assess the preventability of mortality and identify opportunities for improvement. The results were compared with those from previous studies on the PTDR. RESULTS:Of the 1,688 sampled patients, the PTDR was calculated for 929. The overall PTDR was estimated at 13.9%, with a definitive preventable death rate of 2.9% and a potentially preventable death rate of 12.7%. The reduction in PTDR was not statistically significant compared to the 2019 study, which reported a rate of 15.7% (P = 0.261). Significant differences were observed between the preventable and non-preventable groups in terms of age, timing of death, level of medical institution, inter-hospital transfer, means of hospital admission, and time from accident to death. CONCLUSION:In 2021, the PTDR was 13.9%, showing a slight reduction compared to the 2019 study. This study primarily evaluated the performance of Korea's trauma system, with findings highlighting both progress and persistent challenges. Although the study was conducted during the coronavirus disease 2019 pandemic, its potential indirect impact on trauma care is acknowledged as an area for further research. Addressing systemic limitations remains essential for further reducing preventable trauma deaths.

Traumatic brain injury (TBI) is a major public health problem worldwide.Each year, approximately 27 to 69 million people are diagnosed with TBI worldwide, with an estimated incidence of 351 to 939 cases per 100,000 population [1,2].Additionally, the age-standardized incidence of TBI in Korea in 2017 was approximately 476 per 100,000 people [3].According to the most recent report from the Centers for Disease Control and Prevention (CDC) [3], TBI is a leading cause of death and disability, with approximately 210,000 TBI-related hospitalizations in 2020 and 69,000 TBI-related deaths in 2021.The majority of TBIs is preventable, and TBI is influenced not only by injury-related policies, but also by the environment and societal policies such as those regarding 5].Epidemiological studies on TBI are needed to serve as a basis for targeted prevention and effective treatment of patients with brain injury [6].Therefore, we aimed to assess the epidemiologic characteristics of patients with TBI presenting to the national emergency department (ED) using the National Emergency Department Information System (NEDIS), specifically to identify changes in the COVID-19 pandemic era.We also investigated population-based TBI incidence and mortality trends to support future injury-related policy establishments.

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.

BACKGROUND:The preventable trauma death rate survey is a basic tool for the quality management of trauma treatment because it is a method that can intuitively evaluate the level of national trauma treatment. We conducted this study as a national biennial follow-up survey project and report the results of the review of the 2019 trauma death data in Korea. METHODS:From January 1, 2019 to December 31, 2019, of a total of 8,482 trauma deaths throughout the country, 1,692 were sampled from 279 emergency medical institutions in Korea. All cases were evaluated for preventability of death and opportunities for improvement using a multidisciplinary panel review approach. RESULTS:The preventable trauma death rate was estimated to be 15.7%. Of these, 3.1% were judged definitive preventable deaths, and 12.7% were potentially preventable deaths. The odds ratio for preventable traumatic death was 2.56 times higher in transferred patients compared to that of patients who visited the final hospital directly. The group that died 1 hour after the accident had a statistically significantly higher probability of preventable death than that of the group that died within 1 hour after the accident. CONCLUSION:The preventable trauma death rate for trauma deaths in 2019 was 15.7%, which was 4.2%p lower than that in 2017. To improve the quality of trauma treatment, the transfer of severe trauma patients to trauma centers should be more focused.

Background: Although South Korea is a high-income country, its trauma system is comparable to that of low- and middle-income countries (LMICs) with high preventable trauma death rates (PTDRs) (>30%). Since 2012, South Korea has established a national trauma system based on the implementation of regional trauma centers (RTCs) and improvement of the transfer system; this study evaluated its effectiveness.Methods: We compared the national PTDRs, transfer patterns, and outcomes between 2015 and 2017. The trauma death review was conducted by multiple panels and a severity-adjusted logistic regression model was created to identify factors influencing the PTDR. We also compared the number of trauma patients transferred to emergency medical institutions and mortality in models adjusted with injury severity scores.Findings: The PTDR decreased from 2015 to 2017 (30·5% vs. 19·9%, p<0·0001). 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=0·0024) in 2017 than in 2015. RTCs 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% (1,008/47,806) to 1·9% (1,062/55,057) (p=0·041). Interpretation: The national trauma system establishment was associated with significant improvements in performance and outcomes. This was mainly because of the implementation of RTCs where more severe patients were transferred. This study may be a good model for LMICs, which lack a trauma system.Funding Statement: This study was funded by the Ministry of Health and Welfare, Republic of Korea.Declaration of Interests: We declare no competing interests.Ethics Approval Statement: Approval (E-1811-005-982) from the Institutional Review Board of Seoul National University Hospital.

J Acute Care Surg Vol. 8 No. 1, April 2018 Correspondence to: Sung Won Jung, M.D., Ph.D. Department of Surgery, National Medical Center, 245 Eulji-ro, Jung-gu, Seoul 04564, Korea Tel: +82-2-2260-7462 Fax: +82-2-2260-7466 E-mail: sungwon94@naver.com ORCID: http://orcid.org/0000-0002-7537-4731 Purpose: Trauma is a leading cause of death, even in previously healthy and disease-free individuals, and the mortality rate is very high in neck trauma patients. On the other hand, there have been few studies related to neck injuries. This study examined the characteristics and treatment results of trauma-related neck injuries using the data from Korean National Emergency Department Information System. Methods: Neck trauma patients were classified using the 6th Korean Standard Disease Classification system. The patients’ demographic factors, number of surgeries, and clinical results were investigated. Statistical analysis was conducted using SPSS to evaluate the annual differences in the demographic factors; mortality according to the site of injury and type of surgery; and mechanisms of injury. Results: From 2011 to 2014, 2,458 neck trauma patients were treated in hospitals in South Korea. The number of patients admitted to regional and local emergency medical centers was 883 (35.9%) and 1,502 (61.1%), respectively. No significant annual differences were observed in age, sex ratio, location of treatment center, mortality, and injury site (vascular, tracheal, or esophageal). In addition, no significant differences in the cause of injury, performed surgery (%), and mortality according to the injured organ were observed. Conclusion: This study revealed no annual changes in neck injury patients or differences in mortality according to injured organs. This study can be used as a basis for national research on organ-specific injuries, and may help predict the demand for future support projects for the establishment of regional trauma centers. (J Acute Care Surg 2018;8:7-12)