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Trauma Volume and Performance of a Regional Trauma Center in Korea: Initial 5-Year Analysis

  • Yu, Byungchul (Department of Trauma Surgery, Gachon University Gil Medical Center) ;
  • Lee, Giljae (Department of Trauma Surgery, Gachon University Gil Medical Center) ;
  • Lee, Min A (Department of Trauma Surgery, Gachon University Gil Medical Center) ;
  • Choi, Kangkook (Department of Trauma Surgery, Gachon University Gil Medical Center) ;
  • Hyun, Sungyoul (Department of Trauma Surgery, Gachon University Gil Medical Center) ;
  • Jeon, Yangbin (Department of Trauma Surgery, Gachon University Gil Medical Center) ;
  • Yoon, Yong-Cheol (Department of Trauma Surgery, Gachon University Gil Medical Center) ;
  • Lee, Jungnam (Department of Trauma Surgery, Gachon University Gil Medical Center)
  • Received : 2020.01.29
  • Accepted : 2020.03.16
  • Published : 2020.03.30

Abstract

Purpose: We aimed to evaluate the trauma volume and performance indicators during the first 5-year period of operation in a single regional trauma center. Methods: We analyzed prospectively collected data from the Korean Trauma Data Bank for a single regional trauma center between January 2014 and December 2018. More than 250 variables were analyzed. We calculated the predicted survival rates using the trauma and injury severity score (TRISS) method. Results: In total, there were 16,103 trauma admissions during the first 5 years; trauma activation was performed in 5,105 of these cases. Over 70% of the patients were men, and most of the admitted patients were within the age groups of 55-59 years for men and 75-79 years for women. Analyses were performed considering two patient groups: the total patient group and the group of those with severe trauma (injury severity score [ISS] >15). The median ISS, revised trauma score, and TRISS of the two groups were 5 (interquartile range [IQR] 4-10), 22 (IQR 17-27), and 7.6±0.99 and 6.74±1.9, 0.95±0.13, 0.81±2.67, respectively. Of the total patient group, 801 patients (5%) died in the hospital, whereas of the group of patients with ISS >15, 526 (19.5%) died. The direct transportation of patients to the regional trauma center increased year by year. The emergency room stay time and time to entering the operating room showed a decrease until 2017; however, these parameters increased again in 2018. Conclusions: The trauma volume in the regional trauma center is appropriate, and some improvements could be observed after its establishment. However, performance indicators reveal the prematurity of the trauma center and its potential for further improvements. Moreover, the development of a national trauma system, beyond regional trauma centers, is required.

Keywords

References

  1. Statistics Korea. 2018 Result on the cause of death statistics [Internet]. Daejeon: Statistics Korea 2019 [cited 2019 Sep 18]. Available from: http://kostat.go.kr/portal/korea/kor_nw/1/1/index.board?bmode=read&aSeq=377606.
  2. Jung KY, Kim JS, Kim Y. Problems in trauma care and preventable deaths. J Korean Soc Emerg Med 2001;12:45-56.
  3. Kim H , Jung KY, Kim SP, K im SH, Noh H , Jang HY, et al. Changes in preventable death rates and traumatic care systems in Korea. J Korean Soc Emerg Med 2012;23:189-97.
  4. Kim Y, Jung KY, Cho KH, Kim H, Ahn HC, Oh SH, et al. Preventable trauma deaths rates and management errors in emergency medical system in Korea. J Korean Soc Emerg Med 2006;17:385-94.
  5. Nathens AB, Jurkovich GJ, Maier RV, Grossman DC, MacKenzie EJ, Moore M, et al. Relationship between trauma center volume and outcomes. JAMA 2001;285:1164-71. https://doi.org/10.1001/jama.285.9.1164
  6. Groven S, Eken T, Skaga NO, Roise O, Naess PA, Gaarder C. Long-lasting performance improvement after formalization of a dedicated trauma service. J Trauma 2011;70:569-74. https://doi.org/10.1097/TA.0b013e31820d1a9b
  7. MacKenzie EJ, Rivara FP, Jurkovich GJ, Nathens AB, Frey KP, Egleston BL, et al. A national evaluation of the effect of trauma-center care on mortality. N Engl J Med 2006;354:366-78. https://doi.org/10.1056/NEJMsa052049
  8. Committee on Trauma, American College of Surgeons. Resources for optimal care of the injured patient 2014. Chicago (IL): American College of Surgeons; 2014.
  9. Halm EA, Lee C, Chassin MR. Is volume related to outcome in health care? A systematic review and methodologic critique of the literature. Ann Intern Med 2002;137:511-20. https://doi.org/10.7326/0003-4819-137-6-200209170-00012
  10. Jung K, Lee JC-J, Park RW, Yoon D, Jung S, Kim Y, et al. The best prediction model for trauma outcomes of the current Korean population: a comparative study of three injury severity scoring systems. Korean J Criti Care Med 2016;31:221-8. https://doi.org/10.4266/kjccm.2016.00486
  11. Hartl R, Gerber LM, Iacono L, Ni Q, Lyons K, Ghajar J. Direct transport within an organized state trauma system reduces mortality in patients with severe traumatic brain injury. J Trauma 2006;60:1250-6; discussion 1256. https://doi.org/10.1097/01.ta.0000203717.57821.8d
  12. Sampalis JS, Denis R, Frechette P, Brown R, Fleiszer D, Mulder D. Direct transport to tertiary trauma centers versus transfer from lower level facilities: impact on mortality and morbidity among patients with major trauma. J Trauma 1997;43:288-95; discussion 295-6. https://doi.org/10.1097/00005373-199708000-00014
  13. Perdue PW, Watts DD, Kaufmann CR, Trask AL. Differences in mortality between elderly and younger adult trauma patients: geriatric status increases risk of delayed death. J Trauma 1998;45:805-10. https://doi.org/10.1097/00005373-199810000-00034
  14. Kuhne CA, Ruchholtz S, Kaiser GM, Nast-Kolb D; Working Group on Multiple Trauma of the German Society of Trauma. Mortality in severely injured elderly trauma patients--when does age become a risk factor? World J Surg 2005;29:1476-82. https://doi.org/10.1007/s00268-005-7796-y
  15. Yu B, Chung M, Lee G, Lee J. Mortality and morbidity in severely traumatized elderly patients. Korean J Criti Care Med 2014;29:88-92. https://doi.org/10.4266/kjccm.2014.29.2.88
  16. Henderson KI, Coats TJ, Hassan TB, Brohi K. Audit of time to emergency trauma laparotomy. Br J Surg 2000;87:472-6. https://doi.org/10.1046/j.1365-2168.2000.01392.x
  17. Lee DK, Lee KH, Cha KC, Park KH, Choi HJ, Kim H, et al. Effectiveness of simple trauma team activation criteria on prognosis of severe trauma patients. J Traum Inj 2009;22:71-6.
  18. Shim H, Jang JY, Lee JG, Kim S, Kim MJ, Park YS, et al. Application of critical pathway in trauma patients. J Traum Inj 2012;2:159-65.
  19. Norris R, Woods R, Harbrecht B, Fabian T, Rhodes M, Morris J, et al. TRISS unexpected survivors: an outdated standard? J Trauma 2002;52:229-34.
  20. Park Y, Chung M, Lee GJ, Lee MA, Park JJ, Choi KK, et al. Characteristics of Korean trauma patients: a single-center analysis using the Korea trauma database. J Traum Inj 2016;29:155-60. https://doi.org/10.20408/jti.2016.29.4.155

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