Challenges in Saving Trauma Patients in Seoul Based on the 2016–2020 Community-Based Severe Trauma Survey

초록

Background/Objectives: The preventable trauma death rate (PTDR) reflects the quality of trauma management systems. In the Republic of Korea, the PTDR in Seoul, the capital city, decreased from 30.8% in 2015 to 20.4% in 2019. However, it remains the highest in the country. In contrast, Gyeonggi-Incheon, which includes Gyeonggi Province and Incheon Metropolitan City surrounding Seoul, had the lowest nationwide PTDR (27.4% in 2015 to 13.1% in 2019). This study aimed to investigate the characteristics and in-hospital mortality risk factors for patients with trauma in Seoul and Gyeonggi-Incheon. Methods: This retrospective cohort study used data from a 2016 to 2020 Community-Based Severe Trauma Survey. Among 237,616 patients, 24,448 were included in the study after applying the inclusion and exclusion criteria. Results: The proportions of the population with motor vehicle and workers’ compensation insurance increased with increasing injury severity in both regions. The injury severity score (ISS) was significantly higher in GyeonggiIncheon in the ISS < 9 and ISS 9–15 groups. Across all hospital levels, the proportion of patients who visited regional trauma centers in Seoul was low across all three ISS groups (0.2%[n = 26], 0.6%[n = 23], and 1.9%[n = 56] for ISS < 9, ISS 9–15, and ISS > 15, respectively). Conversely, in Gyeonggi-Incheon, the proportion of patients who visited regional trauma centers increased as injury severity increased across all three ISS groups (37.3%[n = 1404], 50.6%[n = 732], and 64.4%[n = 856] for ISS < 9, ISS 9–15, and ISS > 15, respectively). In Seoul, the identified in-hospital mortality risk factors included age, National Health Insurance (NHI) loss, other insurance, ISS, regional and local emergency centers or institutes, and the number of angioembolizations. In Gyeonggi-Incheon, the in-hospital mortality risk factors included age, ISS, falls and slippage, and the number of angioembolizations. Conclusions: The unique in-hospital mortality risk factors in Seoul compared with those in GyeonggiIncheon include transfers to regional emergency centers (ISS > 15), local emergency centers or institutes (ISS > 15), NHI loss (ISS 9–15 and ISS > 15), and the use of other insurance (ISS > 15).

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