Effectiveness of Trauma System Establishment: A National Follow-Up Observational Study From the National Emergency Department Information System in South Korea

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.