Emergency Care Policy Priority: Korea’s Mortality Gaps Point to Severe Infections

A Korean study highlights severe infections and cardiac arrest as emergency care priorities using regional mortality benchmarks. Its estimates describe potential death reductions under policy scenarios, without proving preventability, and require further research before guiding decisions on healthcare funding.

Severe infections and cardiac arrest deserve close attention when Korea decides where to strengthen emergency care, according to a nationwide study published in the Journal of Clinical Medicine. The research, Prioritizing Emergency Medical Conditions for Health Policy Using a Stepwise Treatable-Death Framework: A Nationwide Analysis in Korea, 2018–2022, examined how death counts might change if regional outcomes matched specified domestic benchmarks. The findings offer a way to identify conditions for policy review, with estimates that depend on the chosen targets and do not establish how many deaths better treatment would actually prevent.

How the study measured room for improvement

The researchers examined National Emergency Department Information System data from 16 Korean regions between 2018 and 2022, selecting the 20 conditions with the largest cumulative numbers of deaths during emergency care or subsequent hospitalisation. These became 17 groups after four infection-related diagnoses were combined. The dataset contained 3,384,529 patient records and 357,404 in-hospital deaths, a mortality proportion of 10.56%. Patients dead on arrival were excluded, and regions reflected the treating hospital's location rather than patients' home addresses.

The combined category, called "extended sepsis," included sepsis, bacterial pneumonia, pneumonia with an unspecified organism, and lung inflammation caused by inhaled solids or liquids. It captured a broad infection-related burden in administrative records; some included patients may not have met clinical sepsis criteria. Each record belonged to one study category, avoiding duplicate counting. Extended sepsis accounted for 577,907 patients and 74,284 deaths, with mortality of 12.85%, placing it second for patient numbers and deaths.

The team compared regional deaths with expectations based on national mortality rates for each sex and 10-year age group. The short-term scenario brought regions with mortality above the national reference down to that reference, leaving regions already at or below it unchanged. The mid-term scenario brought every region to the lowest adjusted regional mortality level observed for each condition and year. "Treatable deaths" represented the positive gap between observed deaths and deaths expected under each target. Both scenarios used the same historical period, so their estimates cannot be added together as separate gains.

Severe infections and cardiac arrest lead the estimates

Extended sepsis produced the largest estimated reduction under the short-term target, at 2,387 deaths over five years, followed by bronchus and lung cancer and cardiac arrest. Cardiac arrest moved into first place under the more demanding mid-term target, at 21,547 deaths, followed by extended sepsis at 19,340. The same six groups occupied the leading positions under both scenarios, with their order changing according to the benchmark.

Condition group	Short-term estimate	Mid-term estimate
Extended sepsis	2,387	19,340
Bronchus and lung cancer	1,984	6,715
Cardiac arrest	1,662	21,547
Severe trauma	1,538	7,010
Liver and intrahepatic bile duct cancer	1,226	4,710
Intracranial injury	1,084	5,240

These figures are cumulative estimates for 2018–2022. For extended sepsis, they corresponded to annual averages of about 477 deaths under the short-term scenario and 3,868 under the mid-term scenario. Its prominence came from the combination of many affected patients and a substantial gap from the benchmarks, showing why mortality percentages or death counts alone can give an incomplete picture of potential policy priorities.

Regional patterns survive changes to the calculations

Adjusted mortality exceeded the national reference in at least three of the five years in 10 regions for extended sepsis. Repeated elevations occurred in 12 regions for liver and intrahepatic bile duct cancer, 11 each for pancreatic and lung cancer, and 10 for acute kidney injury. A stricter test accounting for uncertainty identified recurring elevations in three regions for extended sepsis, seven for lung cancer and six for pancreatic cancer. These patterns warrant investigation because differences in illness severity and other patient characteristics could also explain regional variation.

Using the pooled outcomes of the three regions with the lowest adjusted mortality reduced all 17 mid-term estimates, preserving the same leading six conditions. Extended sepsis moved into first place, with estimates of 13,035 using regions selected annually and 13,314 using a pooled five-year benchmark; cardiac arrest ranked second at 11,047 and 11,294. The annually selected benchmark produced a rank correlation of 0.978 with the main analysis and retained all five leading conditions.

Separating the four infection diagnoses showed that pneumonia with an unspecified organism ranked first under the short-term target, at about 1,990 deaths, and second under the main mid-term target, at about 12,955. Sepsis alone ranked seventh and fifth, demonstrating differences within the combined category. Analyses without demographic adjustment broadly preserved the leading priorities, and extended sepsis stayed first for the short-term scenario and among the top two for the mid-term scenario in both the pre-pandemic and pandemic periods.

What a national response could change

The authors propose evaluating a clearer national approach to sepsis, drawing on organized care pathways already developed for heart attacks, stroke, trauma and other major conditions. Suggested measures include consistent surveillance definitions, repeated assessment of patients with suspected infection and developing organ dysfunction, clear escalation rules, timely antimicrobial treatment and procedures to control the infection source.

Regional referral routes for critical care, public and professional education, and regular outcome reporting could support that response. The study did not test whether these measures would achieve its modeled reductions.

The nationwide coverage and five-year analysis strengthen the study's usefulness for identifying priorities. The grouped data lacked information on other illnesses, clinical severity, transfers and hospital characteristics. Deaths after discharge were not captured, and differences in hospital stays or discharge practices could influence comparisons.

The lowest regional benchmark may reflect small patient numbers, chance or coding differences, making it an uncertain target for other regions. Shock could not be separated by cause, so infection-related shock within that category could not be quantified.