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

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

• Kwon J
• Lee JH
• Hwang K
• Heo Y
• Cho HJ
• Lee JCJ
• Jung K

• KMID: 2509752
• DOI: http://doi.org/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.

Keyword

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

Figure

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  Fig. 1 Emergency medical facilities including regional trauma centers in Gyeonggi Province.

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  Fig. 2 Study design and sampling.NEDIS = National Emergency Department Information System.

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