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

J Korean Med Sci. 2020 Dec 28;35(50):e417. doi: 10.3346/jkms.2020.35.e417.

Abstract

Background: Trauma mortality review is the first step in assessing the quality of the trauma treatment system and provides an important basis for establishing a regional inclusive trauma system. This study aimed to obtain a reliable measure of the preventable trauma death rate in a single province in Korea.

Methods: From January to December 2017, a total of 500 sample cases of trauma-related deaths from 64 hospitals in Gyeonggi Province were included. All cases were evaluated for preventability and opportunities for improvement using a multidisciplinary panel review approach.

Results: Overall, 337 cases were included in the calculation for the preventable trauma death rate. The preventable trauma death rate was estimated at 17.0%. The odds ratio was 3.97 folds higher for those who arrived within "1-3 hours" than those who arrived within "1 hour." When the final treatment institution was not a regional trauma center, the odds ratio was 2.39 folds higher than that of a regional trauma center. The most significant stage of preventable trauma death was the hospital stage, during which 86.7% of the cases occurred, of which only 10.3% occurred in the regional trauma center, whereas preventable trauma death was more of a problem at emergency medical institutions.

Conclusion: The preventable trauma death rate was slightly lower in this study than in previous studies, although several problems were noted during inter-hospital transfer; in the hospital stage, more problems were noted at emergency medical care facilities than at regional trauma centers. Further, several opportunities for improvements were discovered regarding bleeding control.

Keywords: Injuries and Wounds; Korea; Preventable Death Rate; Province; Trauma Center; Trauma System.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Emergency Medical Services
  • Emergency Medicine / standards*
  • Emergency Medicine / trends
  • Emergency Service, Hospital
  • Emergency Treatment
  • Female
  • Geography
  • Hemorrhage
  • Hospitals
  • Humans
  • Injury Severity Score
  • Male
  • Middle Aged
  • Mortality*
  • Odds Ratio
  • Reproducibility of Results
  • Republic of Korea
  • Sepsis / mortality*
  • Trauma Centers / statistics & numerical data
  • Wounds and Injuries / mortality*
  • Young Adult