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J Korean Soc Emerg Med > Volume 23(2); 2012 > Article
Journal of The Korean Society of Emergency Medicine 2012;23(2): 189-197.
Changes in Preventable Death Rates and Traumatic Care Systems in Korea
Hyun Kim, Koo Young Jung, Sun Pyo Kim, Sun Hyu Kim, Hyun Noh, Hye Young Jang, Han Deok Yoon, Yun Jung Heo, Hyun Ho Ryu, Tae oh Jeong, Yong Hwang, Jung Min Ju, Myeong Don Joo, Sang Kyoon Han, Kwang Won Cho, Ki Hoon Choi, Joon Min Park, Hyun Min Jung, Soo Bock Lee, Yeon Young Kyong, Ji Yeong Ryu, Woo Chan Jeon, Ji Yun Ahn, Jang Young Lee, Ho Jin Ji, Tae Hun Lee, Oh Hyun Kim, Youg Sung Cha, Kyung Chul Cha, Kang Hyun Lee, Sung Oh Hwang
1Department of Emergency Medicine, Woju College of Medicine, Yonsei University, Wonju, Korea.
2School of Medicine, Ewha Womans University, Seoul, Korea. kyjung@ewha.ac.kr
3Chosun University College of Medicine, Gwangju, Korea.
4Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
5Kwandong University College of Medicine, Goyang, Korea.
6Soonchunhyang University College of Medicine, Seoul, Korea.
7National Emergency Medical Center, Nation Medical Center, Seoul, Korea.
8Ajou University School of Medicine, Suwon, Korea.
9Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Korea.
10Chonbuk National University Hospital, Jeonju, Korea.
11Wonkwang University College of Medicine, Iksan, Korea.
12Mokpo Hankuk Hospital, Mokpo, Korea.
13School of Medicine, Catholic University of Daegu, Daegu, Korea.
14Pusan National University Hospital, Busan, Korea.
15Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.
16Hallym University Hangang Sacred Heart Hospital, Seoul, Korea.
17Inje University Ilsan Paik Hospital, Goyang, Korea.
18Inha University, College of Medicine, Incheon, Korea.
19Gacheon University, Medicine and Science, Incheon, Korea.
20Uijeongbu St.Mary's Hospital, The Catholic University of Korea, Gyeonggi, Korea.
21Hallym University, Kangdong Sacred Heart Hospital, Seoul, Korea.
22Inje University, Ilsan Paik Hospital, Goyang, Korea.
23Hallym University, Sacred Heart Hospital, Anyang, Korea.
24Eulji University, College of Medicine, Daejeon, Korea.
25Andong Hospital, Andong, Korea.
26Hallym University, Chuncheon, Korea.
This study was performed in order to determine the changes over time in preventable and potentially preventable traumatic death rates, and to assess the factors that affected the deaths of trauma patients which occurred in Korean pre-hospital and hospital settings.
All trauma deaths occurring either in the emergency department (ED) or after admission at twenty Korean hospitals between August 2009 and July 2010 were retrospectively analyzed. The deaths were initially reviewed by a team of multidisciplinary specialists and classified into non-preventable, potentially preventable, and preventable deaths. Only preventable and potentially preventable deaths were the subject of our analysis. Structured data extraction included patient demographics, vital signs, injury severity, probability of survival, preventability of mortality, reported errors in the evaluation and management of the patient, and classification of error types (system, judgment, knowledge).
During the study period, 446 trauma victims died in the ED or within 7 days after admission. The mean age was 52 years, 74.1% were men and the mean time from injury to death was 35.6 hours. The most common cause of death was head injury (44.7%) followed by hemorrhage (30.8%) and multi-organ failure (8.0%). The rates of preventable/potentially preventable deaths were 35.2% overall and 29.8% when limited to patients surviving to admission. Of all death classifications, 31.2% were potentially preventable and 4.0% were preventable. Errors leading to preventable death occurred in the emergency department (51.2%), pre-hospital setting (30.3%) and during inter-hospital transfer (60.8%). Most errors were related to clinical management (48.4%) and structural problems in the emergency medical system (36.5%).
The preventable death rates for Korean trauma victims were higher than those found in other developed countries, possibly due to poorly established emergency medical systems for trauma victims in pre-hospital and hospital settings. A system wide approach based on the emergency medical system and well-developed in-hospital trauma teams should be adopted in order to improve the quality of care of trauma victims in Korea.
Key words: Injuries, Emergency medical services, Death
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