LAUSR

BACKGROUND Trauma is a major cause of mortality, disability, and health care costs worldwide. Establishment of a trauma system is known to solve these problems, but few studies have objectively evaluated the impact of a trauma system on outcomes. Since 2012, South Korea has established a national trauma system based on the implementation of 17 regional trauma centers nationwide and improvement of the pre-hospital transfer system. This study aimed to measure the changes in performance and outcome according to the established national trauma system. MATERIAL AND METHODS In this national cohort-based, retrospective follow-up observational study, we calculated the preventable trauma death rate by conducting a multi-panel review of patients who died in 2015, 2017, and 2019. Furthermore, we constructed a risk-adjusted mortality prediction model of 4,767,876 patients between 2015 and 2019 using the extended-International Classification of Disease Injury Severity Scores to compare outcomes. RESULTS The preventable trauma death rate was lower in 2019 than in 2015 (15.7% vs. 30.5, P <0.001) and 2017 (15.7% vs. 19.9%, P<0.001) representing 1,247 additional lives saved in 2019 compared to that in 2015. In the risk-adjusted model, total trauma mortality was highest in 2015 at 0.56%, followed by that in 2016 and 2017 (0.50%), 2018 (0.51%), and 2019 (0.48%), revealing a significant decrease in mortality over the years (P<0.001 for trend), representing nearly 800 additional lives saved. The number of deaths for more severe patients with probability of survival <0.25 significantly decreased from 81.50% in 2015 to 66.17% in 2019 (P<0.001). CONCLUSIONS We observed a significant reduction in preventable trauma death rate and risk-adjusted trauma mortality in the 5-year follow-up since 2015 when the national trauma system was established. These findings could serve as a model for low- and middle-income countries, where trauma systems are not yet established.