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.
Citations
Citations to this article as recorded by
Intentionally self-injured patients have lower mortality when treated at trauma centers versus non-trauma centers in South Korea Jin Woo, Han Zo Choi, Jongkyeong Kang Trauma Surgery & Acute Care Open.2024; 9(1): e001258. CrossRef
The Association Between Inter-Hospital Transfers and the Prognosis of Pediatric Injury in the Emergency Department Darjin Jung, Jin Hee Jung, Jin Hee Kim, Jie Hee Jue, Joong Wan Park, Do Kyun Kim, Jae Yun Jung, Eui Jun Lee, Jin Hee Lee, Dongbum Suh, Hyuksool Kwon Journal of Korean Medical Science.2023;[Epub] CrossRef
Objective Given that there are no studies on diseases that occur by waiting for hospitalization, we aimed to evaluate the main causes of death in the emergency room (ER) and their relationship with overcrowding.
Methods Patients who died in the ER in the past 2 years (pediatrics and trauma victims excluded) were divided into two groups: patients who died within 6 hours of arrival (emergency department [ED] group) and patients who died later (LD group). We compared the causes of death, total vital signs, diagnostic tests performed, and therapy between the groups. We assessed for possible correlation between the number of monthly deaths per group and four variables of overcrowding: number of patients treated per month, waiting time before medical visit (W-Time), mean intervention time (I-Time), and number of patients admitted to the ward per month (NPA).
Results During the two years, 175 patients had died in our ER (52% in ED group and 48% in LD group). The total time spent in the ER was, respectively, 2.9±0.2 hours for ED group and 17.9± 1.5 hours for LD group. The more frequent cause of death was cardiovascular syndrome (30%) in ED group and sepsis (27%) and acute respiratory failure (27%) in LD group. Positive correlations between number of monthly deaths and W-Time (R2 0.51, P<0.001), I-Time (R2 0.73, P< 0.0001), and NPA (R2 0.37, P<0.01) were found only in LD group.
Conclusion Patients with sepsis and acute respiratory failure die after a long stay in the ER, and the risk increases with overcrowding. A fast-track pathway should be considered for hospital admission of critical patients.
Citations
Citations to this article as recorded by
Non-Surgical Causes of Death in the Emergency Department: A Five-Year Monocentric Clinicopathological Study Adrian-Iosif Moldoveanu, Diana Maria Orzata, Gabriel Veniamin Cozma, Radu Gheorghe Dan, Ovidiu Alexandru Mederle, Flavia Zara Medicina.2026; 62(2): 293. CrossRef
Using space technology approach to improve quality in emergency departments in India: a quality improvement program Saravana Kumar, Gunaseelan Vikneswaran, Jitendra Suryavamshi, Srinath Kumar, Manzoor Shaik, G K Reshma, M R Suresh, Alben Sigamani, V C Shanmuganandan, Alexander Thomas, A N Venkatesh, Imron Subhan, M Rajadurai, Sateesh Kumar Kailasam, B Nivetha, K U Sham International Journal for Quality In Health Care.2026;[Epub] CrossRef
Neutrophil to lymphocyte ratio (NLR) and short-term mortality risk in elderly acute medical patients admitted to a University Hospital Emergency Department Gioacchino Galardo, Luca Crisanti, Andrea Gentile, Marco Cornacchia, Francesca Iatomasi, Iacopo Egiddi, Emanuele Puscio, Danilo Menichelli, Francesco Pugliese, Daniele Pastori Internal and Emergency Medicine.2025; 20(2): 553. CrossRef
Diagnostic performance of S100B assay for intracranial hemorrhage detection in patients with mild traumatic brain injury under antiplatelet or anticoagulant therapy Paul-André Poislane, Mathilde Papin, Damien Masson, Nicolas Goffinet, Arthur David, Quentin Le Bastard, Hugo De Carvalho Scientific Reports.2025;[Epub] CrossRef
Invited Editorial: Waiting Room Care is Not the Solution to Emergency Department Boarding Andrew J. Bouland, Juan A. March JACEP Open.2025; 6(3): 100161. CrossRef
Shortening emergency department length of stay: Fast track, short-stay unit and acute medical unit Bei Huang Exploratory Research in Clinical and Social Pharmacy.2025; 19: 100626. CrossRef
Multidisciplinary Staff Experiences of Providing End-of-Life Care in an Acute Hospital Setting Mia Werrett, Joanna McIlveen, Mim Fox Hospitals.2025; 2(3): 15. CrossRef
OrthoMortPred: Predicting one-year mortality following orthopedic hospitalization Filipe Ricardo Carvalho, Paulo Jorge Gavaia, António Brito Camacho International Journal of Medical Informatics.2024; 192: 105657. CrossRef
Comment on: "30 days mortality prognostic value of POCT bio-adrenomedullin and proenkephalin in patients with sepsis in the emergency department" Gabriele VALLI, Francesca DE MARCO, Silvia CASALBONI, Maria P. RUGGIERI Italian Journal of Emergency Medicine.2023;[Epub] CrossRef
Can Acute Care Biomarkers Change Patient’s Management in Sepsis? Salvatore Di Somma, Luca Crisanti Eurasian Journal of Emergency Medicine.2022; 21(2): 79. CrossRef
Characteristics and timing of mortality in children dying in pediatric intensive care: a 5-year experience Edin Botan, Emrah Gün, Emine Kübra Şden, Cansu Yöndem, Anar Gurbanov, Burak Balaban, Fevzi Kahveci, Hasan Özen, Hacer Uçmak, Ali Genco Gençay, Tanil Kendirli Acute and Critical Care.2022; 37(4): 644. CrossRef
30 Days Mortality Prognostic Value of POCT Bio-Adrenomedullin and Proenkephalin in Patients with Sepsis in the Emergency Department Silvia Casalboni, Gabriele Valli, Ferdinando Terlizzi, Marina Mastracchi, Giacomo Fidelio, Francesca De Marco, Caterina Bernardi, Anastasia Chieruzzi, Alessia Curcio, Francesco De Cicco, Nicola Colella, Ilaria Dafne Papasidero, Emanuele Tartarone, Maria P Medicina.2022; 58(12): 1786. CrossRef
Impact of the 24-hour time target policy for emergency departments in South Korea: a mixed method study in a single medical center Sookyung Park, Hansol Chang, Weon Jung, Se Uk Lee, Sung Yeon Hwang, Hee Yoon, Won Chul Cha, Tae Gun Shin, Min Seob Sim, Ik Joon Jo, Taerim Kim BMC Health Services Research.2022;[Epub] CrossRef
Utility of Measuring Circulating Bio-Adrenomedullin and Proenkephalin for 30-Day Mortality Risk Prediction in Patients with COVID-19 and Non-COVID-19 Interstitial Pneumonia in the Emergency Department Ilaria Dafne Papasidero, Gabriele Valli, Dario Marin, Alberto Del Sasso, Antonio De Magistris, Elisa Cennamo, Silvia Casalboni, Francesca De Marco, Roberta Rocchi, Brice Ndogmo Beumo, Valeria Cusani, Mariarosa Gaudio, Oliver Hartmann, Andreas Bergman, Mar Medicina.2022; 58(12): 1852. CrossRef
Usefulness of High-Sensitivity Troponin I in Risk Stratification and Final Disposition of Patients with Acute Heart Failure in the Emergency Department: Comparison between HFpEF vs. HFrEF Luca Crisanti, Gabriele Valli, Elisa Cennamo, Alessandro Capolino, Paolo Fratini, Claudio Cesaro, Gloria Adducchio, Antonio De Magistris, Ferdinando Terlizzi, Maria Pia Ruggieri, Enrico Mirante, Claudio Savoriti, Kalyarat Sukruang, Valentina Valeriano, Fr Medicina.2022; 59(1): 7. CrossRef
Objective The quick sequential organ failure assessment (qSOFA) score, which includes mentation, systolic blood pressure, and respiratory rate, was developed to identify serious sepsis in out-of-hospital or emergency department (ED) settings. We evaluated the ability of the qSOFA score to predict poor outcome in South Korean ED patients with suspected infection.
Methods The qSOFA score was calculated for adult ED patients with suspected infection. Patients who received intravenous or oral antibiotics in the ED were considered to have infection. In-hospital mortality rate, admission rate, intensive care unit (ICU) admission rate, length of hospital stay (LOS), and lactate levels were compared between the qSOFA score groups. Receiver operating characteristic curves and area under the receiver operating characteristic curve values for in-hospital mortality were calculated according to qSOFA cut-off points and lactate levels.
Results Of 2,698 patients, in-hospital mortality occurred in 134 (5.0%). The mortality rate increased with increasing qSOFA score (2.2%, 6.4%, 17.5%, and 42.4% for qSOFA scores 0, 1, 2, and 3, respectively, P<0.001). The admission rate, ICU admission rate, LOS, and lactate level also increased with increasing qSOFA score (all P<0.001). The area under the receiver operating characteristic curve values for predicting in-hospital mortality associated with qSOFA score, lactate ≥2 mmol/L, and lactate ≥4 mmol/L were 0.719 (95% confidence interval [CI], 0.670 to 0.768), 0.657 (95% CI, 0.603 to 0.710), and 0.632 (95% CI, 0.571 to 0.693), respectively.
Conclusion Patients with a higher qSOFA score had higher admission, ICU admission, and in-hospital mortality rates, longer LOS, and higher lactate level. The qSOFA score showed better performance for predicting poor outcome than lactate level.
Citations
Citations to this article as recorded by
Clinical utility of biomarkers for outcomes prediction in adults with suspected sepsis presenting to the emergency department: a synthesis of current evidence Mari Imamura, Sinead N Duggan, Thenmalar Vadiveloo, Jamie G Cooper, Callum T Kaye, Paul Manson, Gianni Virgili, Lorna Aucott, Mike Clarke, Miriam Brazzelli Health Technology Assessment.2026; : 1. CrossRef
The Role of qSOFA, Derived Neutrophil-to-Lymphocyte Ratio, MEWS, and PIRO Scores in Predicting the Severity of Odontogenic Infections in Young and Adult Patients Serban Talpos Niculescu, Robert Avramut, Tareq Hajaj, Raluca Maracineanu, Antonis Perdiou, Roxana Talpos Niculescu, Marius Pricop, Horatiu Urechescu, Florin Urtila, Roxana Radu, Nicoleta Nikolajevic Stoican, Malina Popa Biomedicines.2025; 13(3): 532. CrossRef
Sodium level in patients with sepsis: what is the predictive value? Zain Sayed, Ahmed A. Obiedallah, Soheir M. Kasem, Abdelraouf M.S. Abdelraouf, Kareem S.M. Ismail, Alaa O. Ahmed Research and Opinion in Anesthesia & Intensive Care.2025; 12(1): 35. CrossRef
Lactate Enhanced Quick Sequential Organ Failure Assessment Score (Lqsofa) as a Tool to Predict the Prognosis in Patients of Sepsis in Surgical Intensive Care Unit Akash Sharma, Nitin Garg, Rahul Patel, Pooja Sharma International Journal of Recent Surgical and Medical Sciences.2025; 11: e015. CrossRef
Comparative analysis of Glasgow Coma Scale, quick Sepsis-related Organ Failure Assessment, base excess, and lactate for mortality prediction in critically ill emergency department patients Gürbüz Meral, Şenol Ardıç, Serkan Günay, Kadir Güzel, Ahmet Köse, Hülya Gençbay Durmuş, Serhat Uysal, Aydın Coşkun Turkish Journal of Emergency Medicine.2024; 24(4): 231. CrossRef
Objective Community-acquired pneumonia (CAP) is a major cause of sepsis, and sepsis-related acute organ dysfunction affects patient mortality. Although the quick Sequential Organ Failure Assessment (qSOFA) is a new screening tool for patients with suspected infection, its predictive value for the mortality of patients with CAP has not been validated. Lactate concentration is a valuable biomarker for critically ill patients. Thus, we investigated the predictive value of qSOFA with lactate concentration for in-hospital mortality in patients with CAP in the emergency department (ED).
Methods From January 2015 to June 2015, 443 patients, who were diagnosed with CAP in the ED, were retrospectively analyzed. We defined high qSOFA or lactate concentrations as a qSOFA score ≥2 or a lactate concentration >2 mmol/L upon admission at the ED. The primary outcome was all-cause in-hospital mortality.
Results Among the 443 patients, 44 (9.9%) died. Based on the receiver operating characteristic (ROC) analysis, the areas under the curves for the prediction of mortality were 0.720, 0.652, and 0.686 for qSOFA, CURB-65 (confusion, urea, respiratory rate, blood pressure, and age), and Pneumonia Severity Index, respectively. The area under the ROC curve of qSOFA was lower than that of SOFA (0.720 vs. 0.845, P=0.004). However, the area under the ROC curve of qSOFA with lactate concentration was not significantly different from that of SOFA (0.828 vs. 0.845, P=0.509). The sensitivity and specificity of qSOFA with lactate concentration were 71.4% and 83.2%, respectively.
Conclusion qSOFA with lactate concentration is a useful and practical tool for the early prediction of in-hospital mortality among patients with CAP in the ED.
Citations
Citations to this article as recorded by
Comparison of Shock Indexes, Lactate Level, and Base Deficit in Predicting Mortality in Community-Acquired Pneumonia: A Retrospective Analysis İlter Ağaçkıran, Merve Ağaçkıran Anatolian Journal of Emergency Medicine.2025; 8(4): 182. CrossRef
Comparative Effectiveness of CURB-65 and qSOFA Scores in Predicting Pneumonia Outcomes: A Systematic Review Abdulhadi Gelaidan, Mohanad Almaimani, Yara A Alorfi, Anas Alqahtani, Nawaf G Alaklabi, Shahad M Alshamrani, Raneem Rambo, Joury A Mujahed, Ruba Y Alsulami, Mohammed Namenkani Cureus.2024;[Epub] CrossRef
Clinical characteristics and outcomes of immunocompromised patients with severe community-acquired pneumonia: A single-center retrospective cohort study Xiaojing Wu, Ting Sun, Ying Cai, Tianshu Zhai, Yijie Liu, Sichao Gu, Yun Zhou, Qingyuan Zhan Frontiers in Public Health.2023;[Epub] CrossRef
Severity Scores in COVID-19 Pneumonia: a Multicenter, Retrospective, Cohort Study Arturo Artero, Manuel Madrazo, Mar Fernández-Garcés, Antonio Muiño Miguez, Andrés González García, Anxela Crestelo Vieitez, Elena García Guijarro, Eva María Fonseca Aizpuru, Miriam García Gómez, María Areses Manrique, Carmen Martinez Cilleros, María del P Journal of General Internal Medicine.2021; 36(5): 1338. CrossRef
The role of qSOFA score and biomarkers in assessing severity of community-acquired pneumonia in adults Raluca-Elena Tripon, Victor Cristea, Mihaela-Sorina Lupse Revista Romana de Medicina de Laborator.2021; 29(1): 65. CrossRef
Behandlung von erwachsenen Patienten mit ambulant erworbener Pneumonie – Update 2021 S. Ewig, M. Kolditz, M. Pletz, A. Altiner, W. Albrich, D. Drömann, H. Flick, S. Gatermann, S. Krüger, W. Nehls, M. Panning, J. Rademacher, G. Rohde, J. Rupp, B. Schaaf, H.-J. Heppner, R. Krause, S. Ott, T. Welte, M. Witzenrath Pneumologie.2021; 75(09): 665. CrossRef
Prognostic accuracy of Quick SOFA in older adults hospitalised with community acquired urinary tract infection Manuel Madrazo, Ian López‐Cruz, Rafael Zaragoza, Laura Piles, José María Eiros, Juan Alberola, Arturo Artero International Journal of Clinical Practice.2021;[Epub] CrossRef
Comparison of Different Scoring Systems for Prediction of Mortality and ICU Admission in Elderly CAP Population Chunxin Lv, Yue Chen, Wen Shi, Teng Pan, Jinhai Deng, Jiayi Xu Clinical Interventions in Aging.2021; Volume 16: 1917. CrossRef
A literature review of severity scores for adults with influenza or community-acquired pneumonia – implications for influenza vaccines and therapeutics Katherine Adams, Mark W. Tenforde, Shreya Chodisetty, Benjamin Lee, Eric J. Chow, Wesley H. Self, Manish M. Patel Human Vaccines & Immunotherapeutics.2021; 17(12): 5460. CrossRef
Assessment of Metabolic Dysfunction in Sepsis in a Retrospective Single-Centre Cohort Julien Goutay, Juliette Perche, Aurelia Toussaint, Elodie Drumez, Michael Howsam, Claire Bourel, Benoit Brassart, Alexandre Pierre, Morgan Caplan, Arthur Durand, Marion Houard, Saad Nseir, Raphael Favory, Sébastien Preau, Samuel A. Tisherman Critical Care Research and Practice.2021; 2021: 1. CrossRef
Added value of inflammatory markers to vital signs to predict mortality in patients suspected of severe infection Toshihiko Takada, Jeroen Hoogland, Tetsuhiro Yano, Kotaro Fujii, Ryuto Fujiishi, Jun Miyashita, Taro Takeshima, Michio Hayashi, Teruhisa Azuma, Karel G.M. Moons The American Journal of Emergency Medicine.2020; 38(7): 1389. CrossRef
Prognostic Prediction Value of qSOFA, SOFA, and Admission Lactate in Septic Patients with Community-Acquired Pneumonia in Emergency Department Haijiang Zhou, Tianfei Lan, Shubin Guo Emergency Medicine International.2020; 2020: 1. CrossRef
Efficacy of the quick sequential organ failure assessment for predicting clinical outcomes among community-acquired pneumonia patients presenting in the emergency department Xiangqun Zhang, Bo Liu, Yugeng Liu, Lijuan Ma, Hong Zeng BMC Infectious Diseases.2020;[Epub] CrossRef
Current Issues and Perspectives in Patients with Possible Sepsis at Emergency Departments Ioannis Alexandros Charitos, Skender Topi, Francesca Castellaneta, Donato D’Agostino Antibiotics.2019; 8(2): 56. CrossRef
Clinical Value of Whole Blood Procalcitonin Using Point of Care Testing, Quick Sequential Organ Failure Assessment Score, C-Reactive Protein and Lactate in Emergency Department Patients with Suspected Infection Bo-Sun Shim, Young-Hoon Yoon, Jung-Youn Kim, Young-Duck Cho, Sung-Jun Park, Eu-Sun Lee, Sung-Hyuk Choi Journal of Clinical Medicine.2019; 8(6): 833. CrossRef
Stratified and prognostic value of admission lactate and severity scores in patients with community-acquired pneumonia in emergency department Haijiang Zhou, Tianfei Lan, Shubin Guo Medicine.2019; 98(41): e17479. CrossRef
First
Prev
