응급실 환자의 외부 이송과 사망 간 연관성: NEDIS 데이터를 이용한 전국 단위 연구

Abstract

Objectives: Inappropriate inter-hospital transfers to facilities lacking adequate definitive treatment capabilities have been identified as a major contributor to the elevated mortality observed among critically ill emergency patients. This study aimed to quantify the scale of external transfers as a proxy for inappropriate transfer and to estimate mortality in transferred patients. Methods: This study utilized data from the 2022 National Emergency Department Information System. Due to limitations in the dataset, it was not possible to directly identify mortality specifically attributable to inappropriate transfers; therefore, cases in which the route of arrival was recorded as “external trans fer” were used as a proxy indicator. All emergency department visits were classified into 28 disease groups based on the diagnosis codes of severe conditions. The mortality rate and relative risk asso ciated with external transfers were then calculated. Furthermore, the odds and odds ratio (OR) of mortality among externally transferred patients were estimated after adjusting for potential con founding factors. Results: Transferred patients exhibited a mortality rate of 4.37% following emer gency treatment and hospitalization, which was higher than that of non-transferred patients, with a relative risk ratio of 2.75. The OR for mortality among transferred patients compared to non-trans ferred patients was 1.60 (95% confidence interval: 1.57–1.63). After adjusting for confounding vari ables, the adjusted OR for mortality ranged from 1.23 in Gangwon-do to 2.45 in Gwangju Metropoli tan City, with statistically significant results observed in all regions. Conclusion: External transfer was found to be significantly associated with an increased risk of mortality. Preemptive and compre hensive policy interventions are required to address the inappropriate transfers resulting from re gional disparities in emergency medical resources and inadequate transportation systems.