{"title":"在韩国，在创伤中心接受治疗的故意自伤患者的死亡率低于在非创伤中心接受治疗的患者。","authors":"Jin Woo, Han Zo Choi, Jongkyeong Kang","doi":"10.1136/tsaco-2023-001258","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>This study investigated the characteristics and survival rates of patients with intentional severe trauma (self-harm or suicide) who were transported to either a regional trauma center (TC) or a non-TC facility.</p><p><strong>Methods: </strong>This retrospective, national, population-based, observational, case-control study included patients who sustained intentional severe trauma and had an abnormal Revised Trauma Score at the injury site between January 2018 and December 2019. The data were a community-based severe trauma survey based on data collected from severe injury and multiple casualty patients transported by 119 emergency medical services (EMS), distributed by the Korea Disease Control and Prevention Agency. The treatment hospitals were divided into two types, TC and non-TCs, and several variables, including in-hospital mortality, were compared. Propensity score matching (PSM) was used to mitigate the influence of confounding variables on the survival outcomes.</p><p><strong>Results: </strong>Among the 3864 patients, 872 and 2992 visited TC and non-TC facilities, respectively. The injury severity did not differ significantly between patients treated at TCs and non-TCs (TC, 9; non-TC, 9; p=0.104). However, compared with those treated at non-TCs, patients treated at TCs had a higher rate of surgery or transcatheter arterial embolization (14.2% vs 38.4%; p<0.001) and a higher admission rate to the emergency department (34.4% vs 60.6%; p<0.001). After PSM, 872 patients from both groups were analyzed. Patients treated at TCs exhibited a higher overall survival rate than those treated at non-TCs (76.1% vs 66.9%; p<0.001), and multiple variable logistic regression analysis demonstrated that the causes of injury and transport to the TC were significantly associated.</p><p><strong>Conclusion: </strong>Using Korean EMS data, the results of this study revealed that initial transport to TCs was associated with reduced mortality rates. However, considering the limitations of using data from only 2 years and the retrospective design, further research is warranted.</p><p><strong>Study type: </strong>Retrospective national, population-based observational case-control study.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"9 1","pages":"e001258"},"PeriodicalIF":2.1000,"publicationDate":"2024-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11110604/pdf/","citationCount":"0","resultStr":"{\"title\":\"Intentionally self-injured patients have lower mortality when treated at trauma centers versus non-trauma centers in South Korea.\",\"authors\":\"Jin Woo, Han Zo Choi, Jongkyeong Kang\",\"doi\":\"10.1136/tsaco-2023-001258\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>This study investigated the characteristics and survival rates of patients with intentional severe trauma (self-harm or suicide) who were transported to either a regional trauma center (TC) or a non-TC facility.</p><p><strong>Methods: </strong>This retrospective, national, population-based, observational, case-control study included patients who sustained intentional severe trauma and had an abnormal Revised Trauma Score at the injury site between January 2018 and December 2019. The data were a community-based severe trauma survey based on data collected from severe injury and multiple casualty patients transported by 119 emergency medical services (EMS), distributed by the Korea Disease Control and Prevention Agency. The treatment hospitals were divided into two types, TC and non-TCs, and several variables, including in-hospital mortality, were compared. Propensity score matching (PSM) was used to mitigate the influence of confounding variables on the survival outcomes.</p><p><strong>Results: </strong>Among the 3864 patients, 872 and 2992 visited TC and non-TC facilities, respectively. The injury severity did not differ significantly between patients treated at TCs and non-TCs (TC, 9; non-TC, 9; p=0.104). However, compared with those treated at non-TCs, patients treated at TCs had a higher rate of surgery or transcatheter arterial embolization (14.2% vs 38.4%; p<0.001) and a higher admission rate to the emergency department (34.4% vs 60.6%; p<0.001). After PSM, 872 patients from both groups were analyzed. Patients treated at TCs exhibited a higher overall survival rate than those treated at non-TCs (76.1% vs 66.9%; p<0.001), and multiple variable logistic regression analysis demonstrated that the causes of injury and transport to the TC were significantly associated.</p><p><strong>Conclusion: </strong>Using Korean EMS data, the results of this study revealed that initial transport to TCs was associated with reduced mortality rates. However, considering the limitations of using data from only 2 years and the retrospective design, further research is warranted.</p><p><strong>Study type: </strong>Retrospective national, population-based observational case-control study.</p><p><strong>Level of evidence: </strong>Level III.</p>\",\"PeriodicalId\":23307,\"journal\":{\"name\":\"Trauma Surgery & Acute Care Open\",\"volume\":\"9 1\",\"pages\":\"e001258\"},\"PeriodicalIF\":2.1000,\"publicationDate\":\"2024-05-20\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11110604/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Trauma Surgery & Acute Care Open\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1136/tsaco-2023-001258\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q3\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Trauma Surgery & Acute Care Open","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1136/tsaco-2023-001258","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/1/1 0:00:00","PubModel":"eCollection","JCR":"Q3","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
引用次数: 0
摘要
目的：本研究调查了被送往地区创伤中心（TC）或非创伤中心的故意严重创伤（自残或自杀）患者的特征和存活率：本研究调查了被送往地区创伤中心（TC）或非TC机构的故意严重创伤（自残或自杀）患者的特征和存活率：这项回顾性、全国性、基于人群、观察性、病例对照研究纳入了2018年1月至2019年12月期间遭受故意严重创伤且受伤部位的修订创伤评分异常的患者。数据是一项基于社区的严重创伤调查，数据收集自韩国疾病预防控制机构分发的由119家紧急医疗服务机构（EMS）转运的严重伤害和多重伤亡患者。治疗医院分为两类，即重创医院和非重创医院，并对包括院内死亡率在内的几个变量进行了比较。采用倾向得分匹配法（PSM）来减轻混杂变量对生存结果的影响：在 3864 名患者中，分别有 872 人和 2992 人到过创伤治疗中心和非创伤治疗中心。在创伤治疗中心和非创伤治疗中心接受治疗的患者的受伤严重程度没有明显差异（创伤治疗中心，9；非创伤治疗中心，9；P=0.104）。然而，与在非急诊中心接受治疗的患者相比，在急诊中心接受治疗的患者接受手术或经导管动脉栓塞治疗的比例更高（14.2% vs 38.4%；P=0.104）：通过使用韩国急救数据，本研究结果表明，最初将患者转送至治疗中心与降低死亡率有关。然而，考虑到仅使用两年的数据和回顾性设计的局限性，还需要进一步研究：研究类型：全国性、基于人群的回顾性病例对照观察研究：证据等级：三级。
Intentionally self-injured patients have lower mortality when treated at trauma centers versus non-trauma centers in South Korea.
Objective: This study investigated the characteristics and survival rates of patients with intentional severe trauma (self-harm or suicide) who were transported to either a regional trauma center (TC) or a non-TC facility.
Methods: This retrospective, national, population-based, observational, case-control study included patients who sustained intentional severe trauma and had an abnormal Revised Trauma Score at the injury site between January 2018 and December 2019. The data were a community-based severe trauma survey based on data collected from severe injury and multiple casualty patients transported by 119 emergency medical services (EMS), distributed by the Korea Disease Control and Prevention Agency. The treatment hospitals were divided into two types, TC and non-TCs, and several variables, including in-hospital mortality, were compared. Propensity score matching (PSM) was used to mitigate the influence of confounding variables on the survival outcomes.
Results: Among the 3864 patients, 872 and 2992 visited TC and non-TC facilities, respectively. The injury severity did not differ significantly between patients treated at TCs and non-TCs (TC, 9; non-TC, 9; p=0.104). However, compared with those treated at non-TCs, patients treated at TCs had a higher rate of surgery or transcatheter arterial embolization (14.2% vs 38.4%; p<0.001) and a higher admission rate to the emergency department (34.4% vs 60.6%; p<0.001). After PSM, 872 patients from both groups were analyzed. Patients treated at TCs exhibited a higher overall survival rate than those treated at non-TCs (76.1% vs 66.9%; p<0.001), and multiple variable logistic regression analysis demonstrated that the causes of injury and transport to the TC were significantly associated.
Conclusion: Using Korean EMS data, the results of this study revealed that initial transport to TCs was associated with reduced mortality rates. However, considering the limitations of using data from only 2 years and the retrospective design, further research is warranted.
Study type: Retrospective national, population-based observational case-control study.
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