Impact of direct prehospital transport on mortality in patients with severe trauma based on the injury severity score: a nationwide observational study in the Republic of Korea

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Abstract
Objectives: Severe trauma remains a leading cause of death in the Republic of Korea. In response, regional trauma centers were established in 2012. This study evaluated the impact of direct prehospital transport to trauma centers on in-hospital mortality among patients with severe trauma using the national trauma registry.Methods: This nationwide observational study utilized data from the Korean community-based trauma registry between 2016 and 2020. Patients with an injury severity score >15 who were directly transported from the prehospital setting were included. Variables analyzed encompassed demographics, injury mechanism, transport time, hospital level, and outcomes. The primary outcome was in-hospital mortality. Both logistic regression and decision tree models were employed.Results: A total of 24,567 patients were included. Overall mortality decreased by 5.2% during the study period. Patients transported to level 1 or 2 trauma centers had a lower mortality rate (23.6%) compared to those transported to level 3 or 4 hospitals (28.0%). The proportion of direct transports to high-level centers increased from 46.7% to 64.1% between 2016 and 2020. Despite longer transport times, patients transported to high-level institutions exhibited improved survival, particularly when transport exceeded 30 minutes, suggesting that hospital selection may be more critical than minimizing transport time.Conclusion: Direct transport to high-level trauma centers improves survival among patients with severe trauma, even when transport times are prolonged. These findings support the importance of a well-organized trauma system that emphasizes hospital capability in prehospital triage decisions.

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