Impact of trauma center care on mortality in Gangwon Province in Korea

Kim, Hyun Seong; Kim, Yoon-Seop; Kim, Hye Sim; Kang, Chan Young; Kim, Oh Hyun; Lee, Kang Hyun; Ahn, Gyo Jin

J Korean Soc Emerg Med > Volume 35(5); 2024 > Article

Original Article

Journal of The Korean Society of Emergency Medicine 2024;35(5): 335-344.

Impact of trauma center care on mortality in Gangwon Province in Korea

¹Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
²Artificial Intelligence Bigdata Medical Center, Yonsei University Wonju College of Medicine, Wonju, Korea

Correspondence

Gyo Jin Ahn ,Tel: 033-741-1641, Fax: 033-742-3030, Email: minstrel@yonsei.ac.kr,

Received: September 18, 2023; Revised: November 12, 2023 Accepted: November 17, 2023. Published online: October 30, 2024.

ABSTRACT

Objective:
Although controversial, there is a consensus that regional trauma centers have survival benefits over nonregional trauma centers. In a predominantly rural province with a single regional trauma center, this study compared the inhospital mortality of all trauma patients and severely injured patients between regional and non-regional trauma centers.
Method:
Using the data from the National Emergency Department Information System in Korea, this study examined all trauma patients who visited emergency departments in Gangwon Province between January 2015 and December 2017. The International Classification of Disease-Based Injury Severity Score (ICISS) was used to categorize the severity of the patients. Propensity score matching was used to balance the severity between the two groups.
Results:
Of 23,510 trauma patients, 2,857 and 20,653 were treated in regional and non-regional trauma centers, respectively. After propensity score matching, all patients in the non-regional trauma center group had a 6.27-fold higher risk of mortality than those in the regional trauma center group; severely injured patients, which were defined as those with ICISS <0.9, in the non-regional trauma center group had a 4.90-fold higher risk of mortality than those in the regional trauma center group. The ICISS cutoff values for mortality were 0.9015 and 0.8737 for the non-regional and regional trauma center groups, respectively.
Conclusion:
The conventional paradigms of trauma systems can be used in predominantly rural Korean provinces, because trauma care has better survival benefits in regional trauma centers than in non-regional trauma centers. In addition, severely injured patients should be transported to regional trauma centers from the trauma scene.

Key words: Trauma centers; Injury; Patients; Treatment outcome; Mortality