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. Level of evidence: Level III.

The impact of patient sex on survival after unintentional trauma in Korea: a retrospective, observational, case-control study.

OBJECTIVE: This study aimed to describe the relationship between sex and survival in patients experiencing unintentional trauma. METHODS: This retrospective, national population-based observational, case-control study involved a cohort of Korean trauma patients who were transferred to an emergency department by a Korean emergency medical service from January 1 to December 31, 2018. Propensity score matching was used. The primary outcome was survival until hospital discharge. RESULTS: Of 25,743 patients with severe unintentional trauma, 17,771 were male and 7,972 were female. Prior to propensity score matching, there was no significant difference in survival among male and female patients (92.6% vs. 93.1%, P=0.105). After using propensity score matching to adjust for confounders, there was still no sex difference in survival (male, 93.6% vs. female, 93.1%; P=0.270). CONCLUSION: Survival after severe trauma was not influenced by the sex of the patient. Further studies with patients of reproductive age and a larger study population are needed to analyze the effects of sex on survival in patients with trauma.

Survival benefit of direct transport to trauma centers among patients with unintentional injuries in Korea: a propensity score-matched analysis.

OBJECTIVE: This study investigated the characteristics and survival rates of patients with unintentional severe trauma who visited a regional trauma center (TC) or a non-TC. METHODS: This retrospective, national, population-based, observational, case-control study included patients with abnormal Revised Trauma Score from January 2018 to December 2018. We divided hospitals into two types, TC and non-TC, and compared several variables, including in-hospital mortality. Propensity score matching was used to reduce the effect of confounding variables that influence survival outcome variables. RESULTS: Of the 25,743 patients, 5,796 visited a TC and 19,947 visited a non-TC. Compared to patients treated at non-TCs, patients treated at TCs were more likely to have a higher Injury Severity Score (TC, 11.5; non-TC, 7.4; P<0.001), higher rate of surgery or transcatheter arterial embolization (TC, 39.2%; non-TC, 17.6%; P<0.001), and higher admission rate (TC, 64.7%; non-TC, 36.9%; P<0.001) through the emergency department. After propensity score matching, 2,800 patients from both groups were analyzed. Patients in the TC had a higher survival rate than patients that were not treated in the TC (TC, 83.0%; non-TC, 78.6%; P=0.003). CONCLUSION: This study using Korean emergency medical services data showed that initial transport to trauma centers was associated with mortality reduction. Further research is required because of limitations with use of single-year data and retrospective design.

Association between in vitro fertilization success rate and ambient air pollution: a possible explanation of within-year variation of in vitro fertilization success rate.

OBJECTIVE: To evaluate patterns in air pollution concentrations and in vitro fertilization (IVF) success rates using data from a large, long-term clinical database. METHODS: We conducted a retrospective cohort study investigating South Korean women who pursued IVF and embryo transfer (IVF-ET) between 2011 and 2017. Hourly concentrations of air pollutants measured at 318 air quality monitoring sites in South Korea between 2011 and 2017 were obtained from the National Institute of Environmental Research. Monthly trends in pregnancy rates and concentrations of air pollutants were assessed. RESULTS: A total of 34,427 IVF-ET cycles in 18,478 patients were analyzed. The mean age of women at the time of IVF-ET was 36.6 years. The clinical pregnancy rate in the IVF-ET cycle was 30%. Analysis of pregnancy failure rates by month showed that IVF-ET failure rates tended to be higher in March and April and lower in July and August. Concentrations of air pollutants including particulate matter (PM) less than 10 µm in diameter, PM less than 2.5 µm in diameter, sulfur dioxide, nitrogen dioxide, and carbon monoxide were highest in March and April and lowest between July and September. CONCLUSION: Within-year variations were similar between IVF-ET failure rates and air pollution concentrations based on analysis of a large, long-term database. Specifically, IVF-ET success rates were highest when PM concentrations were lowest. Further studies are warranted to examine the mechanisms accounting for the association between IVF success and air pollutant exposure.