Journal of Trauma and Injury

The Korean Society of Traumatology (대한외상학회)
권호 표지
DOI QR코드

DOI QR Code

Effectiveness after Designation of a Trauma Center: Experience with Operating a Trauma Team at a Private Hospital

  • Kim, Kyoung Hwan (Department of Trauma Surgery, Trauma Center, Cheju Halla General Hospital) ;
  • Han, Sung Ho (Department of Trauma Surgery, Trauma Center, Cheju Halla General Hospital) ;
  • Chon, Soon-Ho (Department of Trauma Surgery, Trauma Center, Cheju Halla General Hospital) ;
  • Kim, Joongsuck (Department of Trauma Surgery, Trauma Center, Cheju Halla General Hospital) ;
  • Kwon, Oh Sang (Department of Trauma Surgery, Trauma Center, Cheju Halla General Hospital) ;
  • Lee, Min Koo (Department of Trauma Surgery, Trauma Center, Cheju Halla General Hospital) ;
  • Lee, Hohyoung (Department of Trauma Surgery, Trauma Center, Cheju Halla General Hospital)
  • Received : 2018.11.26
  • Accepted : 2018.12.19
  • Published : 2019.03.31
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: The present study aimed to evaluate the influence of how the trauma care system applied on the management of trauma patient within the region. Methods: We divided the patients in a pre-trauma system group and a post-trauma system group according to the time when we began to apply the trauma care system in the Halla Hospital after designation of a trauma center. We compared annual general characteristics, injury severity score, the average numbers of the major trauma patients, clinical outcomes of the emergency department, and mortality rates between the two groups. Results: No significant differences were found in the annual patients' average age ($54.1{\pm}20.0$ vs. $52.8{\pm}18.2$, p=0.201), transportation pathways (p=0.462), injury mechanism (p=0.486), injury severity score (22.93 vs. 23.96, p=0.877), emergency room (ER) stay in minutes (199.17 vs. 194.29, p=0.935), time to operation or procedure in minutes (154.07 vs. 142.1, p=0.767), time interval to intensive care unit (ICU) in minutes (219.54 vs. 237.13, p=0.662). The W score and Z score indicated better outcomes in post-trauma system group than in pre-trauma system group (W scores, 2.186 vs. 2.027; Z scores, 2.189 vs. 1.928). However, when analyzing survival rates for each department, in the neurosurgery department, in comparison with W score and Z score, both W score were positive and Z core was higher than +1.96. (pre-trauma group: 3.426, 2.335 vs. post-trauma group: 4.17, 1.967). In other than the neurosurgery department, W score was positive after selection, but Z score was less than +1.96, which is not a meaningful outcome of treatment (pre-trauma group: -0.358, -0.271 vs. post-trauma group: 1.071, 0.958). Conclusions: There were significant increases in patient numbers and improvement in survival rate after the introduction of the trauma system. However, there were no remarkable change in ER stay, time to ICU admission, time interval to emergent procedure or operation, and survival rates except neurosurgery. To achieve meaningful survival rates and the result of the rise of the trauma index, we will need to secure sufficient manpower, including specialists in various surgical area as well as rapid establishment of the trauma center.

Keywords

References

  1. Statistics of Korea. Death rates for the cause of death [Internet]. Daejeon: Statistics Korea [cited 2017 Nov 1]. Available from: http://kostat.go.kr/assist/synap/preview/skin/doc.html?fn=synapview363268_5&rs=/assist/synap/preview.
  2. Nathens AB, Brunet FP, Maier RV. Development of trauma system and effect on outcomes after injury. Lancet 2004;363:1794-801. https://doi.org/10.1016/S0140-6736(04)16307-1
  3. Teixeira PG, Inaba K, Hadjizachari P, Brown C, Salim A, Rhee P, et al. Preventable or potentially preventable mortality at a mature trauma center. J Trauma 2007;63:1338-46; discussion 1346-7. https://doi.org/10.1097/TA.0b013e31815078ae
  4. Kim H, Jung KY, Kim SP, Kim SH, Noh H, Jang HY, et al. Changes in preventable death rates and traumatic care systems in Korea. J Korean Soc Emerg Med 2012;23:187-97.
  5. Ministry of Health and Welfare. Public participation in five locations for installation and support of the regional trauma center [Internet]. Sejong: Press release of Ministry of Health & Welfare [cited 2018 May 1]. Available from: http://www.mohw.go.kr/react/al/sal0301vw.jsp?PAR_MENU_ID=04&MENU_ID=0403&page=2&CONT_SEQ=275895&SEARCHKEY=TITLE&SEARCHVALUE=%EA%B6%8C%EC%97%AD%EC%99%B8%EC%83%81%EC%84%BC%ED%84%B0.
  6. Kang JH, Park KH, Kim WJ, Kang YJ, Park JO, Cha WC, et al. Problems of trauma care and rate of preventable trauma death in Jeju, South Korea. J Korean Soc Emerg Med 2011;22:438-45.
  7. Boyd CR, Tolson MA, Copes WS. Evaluating trauma care: the TRISS method. Trauma score and the injury severity score. J Trauma 1987;27:370-8. https://doi.org/10.1097/00005373-198704000-00005
  8. Younger PA, Coats TJ, Gurney D, Kirk CJ. Interpretation of the Ws statistic: application to an integrated trauma system. J Trauma 1997;43:511-5. https://doi.org/10.1097/00005373-199709000-00021
  9. Dutton RP, Stansbury LG, Leone S, Kramer E, Hess JR, Scalea TM. Trauma mortality in mature trauma systems: are we doing better? An analysis of trauma mortality patterns, 1997-2008. J Trauma 2010;69:620-6. https://doi.org/10.1097/TA.0b013e3181bbfe2a
  10. Haas B, Stukel TA, Gomez D, Zagorski B, De Mestral C, sharma SV, et al. The mortality benefit of direct trauma center transport in a regional trauma system: a population-based analysis. J Trauma Acute Care Surg 2012;72:1510-5; discussion 1515-7. https://doi.org/10.1097/TA.0b013e318252510a
  11. 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;26;354:366-78. https://doi.org/10.1056/NEJMsa052049
  12. Shim H, Jang JY, Lee JG, Kim S, Kim MJ, Park YS, et al. Application of critical pathway in trauma patients. J Trauma Inj 2012;25:159-65.
  13. Cherry RA, King TS, Carney DE, Bryant P, Cooney RN. Trauma team activation and the impact on mortality. J Trauma 2007;63:326-30. https://doi.org/10.1097/TA.0b013e31811eaad1
  14. Carr BG, Kaye AJ, Wiebe DJ, Gracias VH, Schwab CW, Reilly PM. Emergency department length of stay: a major risk factor for pneumonia in intubated blunt trauma patients. J Trauma 2007;63:9-12. https://doi.org/10.1097/TA.0b013e31805d8f6b
  15. Kim HW, Hong TH, Lee SH, Jung MJ, Lee JG. The influence of how the trauma care system is applied at the trauma center: the initial experience at single trauma center. J Trauma Inj 2015;28:241-7. https://doi.org/10.20408/jti.2015.28.4.241
  16. Baxt WG, Moody P. The differential survival of trauma patients. J Trauma 1987;27:602-6. https://doi.org/10.1097/00005373-198706000-00003
  17. Lee SH, Cho SJ, Yeom SR, Ryu JH, Jung JW, Han SK, et al. Effect of the emergency trauma team's management on the treatment of patients with multiple severe trauma. J Korean Soc Traumatol 2009;22:172-8.
  18. Ivatury RR, Guilford K, Malhotra AK, Duane T, Aboutanos M, Martin N. Patient safety in trauma: maximal impact management errors at a level I trauma center. J Trauma 2008;64:265-70;discussion 270-2. https://doi.org/10.1097/TA.0b013e318163359d
  19. McDermott FT, Codner SM, Cooper DJ, Winship VC, Consultative Committee on Road Traffic Fatalities in Victoria. Management deficiencies and death preventability of road traffic fatalities before and after a new trauma care system in Victoria, Australia. J Trauma 2007;63:331-8. https://doi.org/10.1097/TA.0b013e31806dc5c4
  20. Jung K, Lee JC, Kim J. Injury severity scoring system for trauma patients and trauma outcomes research in Korea. J Acute Care Surg 2016;6:11-7. https://doi.org/10.17479/jacs.2016.6.1.11