Severe Fever With Thrombocytopenia Syndrome in Korea: Assessing the Impact of Hospital Patient Volume on Care Quality and Policy Implications

Background:The case fatality rate of severe fever with thrombocytopenia syndrome (SFTS) in South Korea remains high.We aimed to assess whether hospital patient volume affects the quality of care and clinical outcomes, to provide policy-relevant insights to enhance SFTS management.Methods: We retrospectively analyzed all SFTS patients reported to the Korea Disease Control and Prevention Agency (KDCA) from 2016 to 2021.Detailed clinical variables were collected from patients treated at 28 participating hospitals.SFTS management was compared according to hospital patient volume.The infectious disease physicians at the study hospitals were surveyed about their unmet needs in SFTS care.Results: A total of 1,328 SFTS patients from 163 hospitals were reported during the study period.Of these, 60.7% (99/163) treated fewer than one patient per year.The distribution of patients was uneven across the country, with the highest annual incidence of 1.91 cases per 100,000 population in Gangwon province.From 657 patients across 28 study hospitals, five high-volume hospitals were compared with 12 low-volume hospitals to evaluate differences at both extremes.High-volume hospitals had a shorter median turn-around time for formal results compared to low-volume hospitals (4 days [interquartile range, IQR 2-6] vs. 7 days [IQR 4-13], P < 0.001).Among three testing institutions, the turn-around time for formal results was shortest in-house testing, followed by the Health and Environment Research Institutes, and then KDCA (3 days [IQR 1.5-4] vs. 5 days [IQR 3-7] vs. 18.5 days [IQR 12-22.25],all post hoc P 0.007).The case fatality rate was not significantly different between the groups (16.9%, 42/248 vs. 13.8%,17/123; P = 0.440).The survey showed that among 27 responders, the most commonly reported difficulty in SFTS care was delayed turn-around time of diagnostic tests (85.2%).Conclusion: SFTS cases occurred sporadically and rarely across the country, and the level of clinical expertise in managing SFTS varied between hospitals depending on patient volume.However, the case fatality rate showed no significant difference.Regional centralization of SFTS patients may be helpful in terms of improving quality of care and facilitating clinical trials for experimental therapeutics.