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Yeung WH, Wong John KS, Tsui KL, Lam Tommy SK, Lui CT, Lau CL. Can mechanism of injury improve trauma diversion? A retrospective cross-sectional study. HONG KONG J EMERG ME 2022. [DOI: 10.1177/10249079221087800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: The objective of this study was to determine the impact of adding selected mechanism of injury (MOI) to the existing trauma diversion criteria adopted in Hong Kong. Method: This is a cross-sectional study based on the trauma registry of New Territory West Cluster (NTWC) of Hospital Authority from January 2017 to December 2019. All adult patients aged 18 years or above were recruited if their injury occurred in the catchment area of Pok Oi Hospital (POH) or Tin Shui Wai Hospital (TSWH). Performance of the protocol before and after MOI criteria being added in terms of over-diversion and under-diversion rate was determined. Model discrimination was evaluated by plotting the receiver operating characteristic curve, and the area under the curve was compared before and after MOI criteria added. Net reclassification improvement and integrated discrimination improvement indices were evaluated. Result: A total of 502 patients were included for analysis. Before MOI criteria were added, the over-diversion rate and under-diversion rate were 31.1% and 54.7%, respectively. After MOI criteria were added, the over-diversion rate and under-diversion rate were 33.1% and 34.3%, respectively. The receiver operating characteristic curve of current primary trauma diversion (PTD) criteria had an area under the curve of 66.9% (95% confidence interval: 63%–71%). After adding MOI criteria, the new receiver operating characteristic curve yielded an area under the curve of 73.7% (95% confidence interval: 70%–78%), which is significantly better (p < 0.001). Net reclassification improvement and integrated discrimination improvement indices indicated that including MOI criteria would improve the model prediction. Conclusion: Adding mechanism of injury can improve trauma diversion protocol performance.
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Affiliation(s)
- Wai Hung Yeung
- Accident & Emergency Department, Pok Oi Hospital, Hong Kong
| | | | | | | | - Chun Tat Lui
- Accident & Emergency Department, Tuen Mun Hospital, Hong Kong
| | - Chu Leung Lau
- Accident & Emergency Department, Pok Oi Hospital, Hong Kong
- Accident & Emergency Department, Tuen Mun Hospital, Hong Kong
- Accident & Emergency Department, Tin Shui Wai Hospital, Hong Kong
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Lai CY, Maegele M, Yeung JHH, Lefering R, Hung KCK, Chan PSL, Leung M, Wong HT, Wong JKS, Graham CA, Cheng CH, Cheung NK. Major trauma care in Hong Kong and Germany: a trauma registry data benchmark study. Eur J Trauma Emerg Surg 2020; 47:1581-1590. [PMID: 32128612 DOI: 10.1007/s00068-020-01311-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 01/23/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Trauma remains a leading cause of death and effective trauma management within a well-developed trauma system has been shown to reduce morbidity and mortality. A trauma registry, as an integral part of a mature trauma system, can be used to monitor the quality of trauma care and to provide a means to compare local versus international standards. Hong Kong and Germany both have highly developed health care services. We compared the performance of trauma systems including outcomes among major trauma victims (ISS > 15) over a 3-year period (2013-2015) in both settings using trauma registry data. METHODS This study was a retrospective analysis of prospectively collected data from trauma registries in Hong Kong and Germany. Data from 01/2013 to 12/2015 were extracted from the trauma registries of the five trauma centers in Hong Kong and the TraumaRegister DGU® (TR-DGU). The study cohort included adults (≥ 18 years) with major trauma (ISS > 15). Data related to patient characteristics, nature of the injury, prognostic parameters to calculate the RISC II score, outcomes and clinical management were collected and compared. RESULTS Datasets from 1,864 Hong Kong and 10,952 German trauma victims were retrieved from respective trauma registries. The unadjusted mortality in Hong Kong (22.4%) was higher compared to Germany (19.2%); the difference between observed and expected mortality was higher in Hong Kong (+ 2.7%) than in Germany (- 0.5%). The standardized mortality ratio (SMR) in Hong Kong and Germany were 1.138 (95% CI 1.033-1.252) and 0.974 (95% CI 0.933-1.016), respectively, and the adjusted death rate in Hong Kong was significantly higher compared to the calculated RISC II data. However, patients in Hong Kong were significantly older, had more pre-trauma co-morbidities, more head injuries, shorter hospital and ICU stays and lower ICU admission rates. CONCLUSION Hong Kong had a higher mortality rate and a statistically significantly higher standardized mortality ratio (SMR) after RISC II adjustment. However, multiple differences existed between trauma systems and patient characteristics.
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Affiliation(s)
- Chun Yu Lai
- Accident and Emergency Department, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, The New Territories, Hong Kong.,Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, The New Territories, Hong Kong
| | - Marc Maegele
- Department of Trauma and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC), University Witten/Herdecke (UW/H), Campus Cologne-Merheim, Ostmerheimerstr. 200, 51109, Cologne, Germany. .,Insitute for Research in Operative Medicine (IFOM), University Witten/Herdecke (UW/H), Campus Cologne-Merheim, Ostmerheimerstr. 200, 51109, Cologne, Germany.
| | - Janice Hiu Hung Yeung
- Accident and Emergency Department, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, The New Territories, Hong Kong.,Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, The New Territories, Hong Kong
| | - Rolf Lefering
- Department of Trauma and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC), University Witten/Herdecke (UW/H), Campus Cologne-Merheim, Ostmerheimerstr. 200, 51109, Cologne, Germany.,Insitute for Research in Operative Medicine (IFOM), University Witten/Herdecke (UW/H), Campus Cologne-Merheim, Ostmerheimerstr. 200, 51109, Cologne, Germany
| | - Kei Ching Kevin Hung
- Accident and Emergency Department, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, The New Territories, Hong Kong.,Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, The New Territories, Hong Kong
| | - Po Shan Lily Chan
- Trauma Service, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong
| | - Ming Leung
- Department of Surgery, Princess Margaret Hospital, 2-10 Princess Margaret Hospital Road, Lai Chi Kok, Kowloon, Hong Kong
| | - Hay Tai Wong
- Trauma Service, Queen Mary Hospital, 102 Pok Fu Lam Road, Hong Kong Island, Hong Kong
| | - John Kit Shing Wong
- Trauma Service, Tuen Mun Hospital, 23 Tsing Chung Koon Road, Tuen Mun, The New Territories, Hong Kong
| | - Colin Alexander Graham
- Accident and Emergency Department, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, The New Territories, Hong Kong.,Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, The New Territories, Hong Kong
| | - Chi Hung Cheng
- Accident and Emergency Department, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, The New Territories, Hong Kong.,Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, The New Territories, Hong Kong
| | - Nai Kwong Cheung
- Accident and Emergency Department, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, The New Territories, Hong Kong.,Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, The New Territories, Hong Kong
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Alenyo AN, Smith WP, McCaul M, Van Hoving DJ. A Comparison Between Differently Skilled Prehospital Emergency Care Providers in Major-Incident Triage in South Africa. Prehosp Disaster Med 2018; 33:575-80. [PMID: 30156169 DOI: 10.1017/S1049023X18000699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
IntroductionMajor-incident triage ensures effective emergency care and utilization of resources. Prehospital emergency care providers are often the first medical professionals to arrive at any major incident and should be competent in primary triage. However, various factors (including level of training) influence their triage performance.Hypothesis/ProblemThe aim of this study was to determine the difference in major-incident triage performance between different training levels of prehospital emergency care providers in South Africa utilizing the Triage Sieve algorithm. METHODS This was a cross-sectional study involving differently trained prehospital providers: Advanced Life Support (ALS); Intermediate Life Support (ILS); and Basic Life Support (BLS). Participants wrote a validated 20-question pre-test before completing major-incident training. Two post-tests were also completed: a 20-question written test and a three-question face-to-face evaluation. Outcomes measured were triage accuracy and duration of triage. The effect of level of training, gender, age, previous major-incident training, and duration of service were determined. RESULTS A total of 129 prehospital providers participated. The mean age was 33.4 years and 65 (50.4%) were male. Most (n=87; 67.4%) were BLS providers. The overall correct triage score pre-training was 53.9% (95% CI, 51.98 to 55.83), over-triage 31.4% (95% CI, 29.66 to 33.2), and under-triage 13.8% (95% CI, 12.55 to 12.22). Post-training, the overall correct triage score increased to 63.6% (95% CI, 61.72 to 65.44), over-triage decreased to 17.9% (95% CI, 16.47 to 19.43), and under-triage increased to 17.8% (95% CI, 16.40 to 19.36). The ALS providers had both the highest likelihood of a correct triage score post-training (odds ratio 1.21; 95% CI, 0.96-1.53) and the shortest duration of triage (median three seconds, interquartile range two to seven seconds; P=.034). Participants with prior major-incident training performed better (P=.001). CONCLUSION Accuracy of major-incident triage across all levels of prehospital providers in South Africa is less than optimal with non-significant differences post-major-incident training. Prior major-incident training played a significant role in triage accuracy indicating that training should be an ongoing process. Although ALS providers were the quickest to complete triage, this difference was not clinically significant. The BLS and ILS providers with major-incident training can thus be utilized for primary major-incident triage allowing ALS providers to focus on more clinical roles. AlenyoAN, SmithWP, McCaulM, Van HovingDJ. A comparison between differently skilled prehospital emergency care providers in major-incident triage in South Africa. Prehosp Disaster Med. 2018;33(6):575-580.
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Abstract
Objective To review the categorisation of patients who were transferred out from out-lying islands to urban hospitals utilising casualty evacuation (CASEVAC), and to search for possible patient characteristics which might have contributed to mis-categorisation during the ‘non-flying’ hours. Methods The medical records of 459 patients, who were transferred out in the year 2009 were reviewed. Correctness of categorisation was determined by 2 independent assessors according to the CASEVAC guidelines. The rates of mis-categorisation between ‘clinic hours’ and ‘AED hours’, and that between the ‘flying’ and ‘non-flying’ hours, were compared. The patients' demographic data and their presenting symptoms were collected and analysed using logistic regression models to identify factors contributing to mis-categorisation. Results The mis-categorisation rate was 60.1%. Among them, all were over-categorised. The over-categorisation rates between ‘clinic hours’ and ‘AED hours’, and between ‘flying’ and ‘non-flying’ hours, were not significantly different (p=0.07 and 0.09, respectively). Abnormal pulse rate was significantly associated with over-categorisation (p<0.01). Patients at extremes of age and psychiatric/drunk patients were significantly less likely to be over-categorised (p<0.05 and p<0.01, respectively). There was 20% disagreement between the two assessors when applying the existing CASEVACs guidelines (kappa score 0.58 or ‘moderate agreement’). Conclusions Over-triage in CASEVAC categorisation is common irrespective of the time of day. Revision of the current CASEVAC guidelines is recommended. (Hong Kong j.emerg.med. 2013; 20:327-336)
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Mok Y, Ma H, Leung M, Yeung H, Lit A, Luk H. Clinical Outcomes of Trauma Patients after Implementation of a Standardised Diversion Protocol for Trauma Patients in Two Regional Hospitals in Hong Kong. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791502200401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction Despite recent advance in prehospital trauma diversion, patients are triaged to the nearest medical facility before transferred to designated trauma centre. A new standardised diversion protocol for trauma patients was implemented on 1st April 2011 to facilitate trauma care. Severely-injured patients were transferred to designated trauma centre directly from emergency department of the regional hospital after initial resuscitation. Objective This study was undertaken to examine clinical outcomes of trauma patients after implementation of the new standardised diversion protocol for trauma patients in the emergency department. Method This was a before-and-after interventional study on trauma patients presenting to the emergency department in critical or emergency conditions during the study period from 1st April 2011 to 31st March 2012. Patients presented in the two-year period before implementation of the trauma protocol were used as historical control. Medical records of eligible cases were reviewed. Main outcome measures were 30-day mortality, length of hospital stay and time to definitive care. Mortality data was compared with oversea standard by TRISS methodology. Results There were 153 eligible patients in the study group and 355 in the historical control group. After new arrangement of trauma diversion, W-statistics improves from -1.26 to 0.09. Z-statistics was -2.03 before and 0.09 after implementation. M-statistics were 0.91 before and 0.88 after the new protocol. Mean time to definitive care was shortened by 33.4 minutes in the subgroup who were transferred to trauma centre after trauma team activation (p=0.005). Conclusion A trend of improved outcomes and shorter time to definitive care are observed after implementation of the new trauma diversion protocol. (Hong Kong j.emerg.med. 2015;22:201-209)
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Affiliation(s)
- Yt Mok
- Yan Chai Hospital, Accident and Emergency Department, 7-11 Yan Chai Street, Tsuen Wan, New Territories, Hong Kong
| | - Hm Ma
- Yan Chai Hospital, Accident and Emergency Department, 7-11 Yan Chai Street, Tsuen Wan, New Territories, Hong Kong
| | - M Leung
- Yan Chai Hospital, Accident and Emergency Department, 7-11 Yan Chai Street, Tsuen Wan, New Territories, Hong Kong
| | - Hc Yeung
- Yan Chai Hospital, Accident and Emergency Department, 7-11 Yan Chai Street, Tsuen Wan, New Territories, Hong Kong
| | - Ach Lit
- Yan Chai Hospital, Accident and Emergency Department, 7-11 Yan Chai Street, Tsuen Wan, New Territories, Hong Kong
| | - Ht Luk
- Yan Chai Hospital, Accident and Emergency Department, 7-11 Yan Chai Street, Tsuen Wan, New Territories, Hong Kong
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Abstract
PURPOSE To evaluate the performance of a prehospital trauma diversion system in Hong Kong, China. METHODS A retrospective analysis of prospectively collected data in the trauma registry of Queen Mary Hospital, Hong Kong from 1 January 2009 to 31 December 2013 was done. All adult patients aged 18 years or above, either primarily or secondarily diverted to Queen Mary Hospital according to the trauma patient diversion protocol, were recruited. Need for trauma center level of care was based on a consensus-based criterion standard published in 2014. Performance of the protocol in terms of over- diversion and under-diversion was determined. RESULTS A total of 209 patients were included for analysis. About 30% of the patients required trauma center level of care. The most common reason was the need for vascular, neurologic, abdominal, thoracic, pelvic, spine or limb-conserving surgery within 24 h of presentation. The over-diversion rate and under- diversion rate were 69.6% and 19.7% respectively. CONCLUSION The trauma patient diversion protocol currently in use in Hong Kong is not accurate enough. Further revision and refinement is needed.
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Affiliation(s)
- Tak-Wai Lui
- Department of Medicine, Queen Mary Hospital, Hong Kong, China
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Yu J, Tam HM, Lee TM. Traumatic Brain Injury Rehabilitation in Hong Kong: A Review of Practice and Research. Behav Neurol 2015; 2015:274326. [PMID: 26557738 DOI: 10.1155/2015/274326] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 08/21/2015] [Accepted: 09/03/2015] [Indexed: 11/21/2022] Open
Abstract
Background. The rising public health concern regarding traumatic brain injury (TBI) implies a growing need for rehabilitation services for patients surviving TBI. Methods. To this end, this paper reviews the practices and research on TBI rehabilitation in Hong Kong so as to inform future developments in this area. This paper begins by introducing the general situation of TBI patients in Hong Kong and the need for rehabilitation. Next, the trauma system in Hong Kong is introduced. Following that is a detailed description of the rehabilitation services for TBI patients in Hong Kong, as exemplified by a rehabilitation hospital in Hong Kong. This paper will also review intervention studies on rehabilitating brain-injured populations in Hong Kong with respect to various rehabilitation goals. Lastly, the implications of culture-related issues will be discussed in relation to TBI. Results/Conclusions. The intervention studies conducted in Hong Kong are generally successful in achieving various rehabilitative outcomes. Additionally, certain cultural-related issues, such as the stigma associated with TBI, may impede the rehabilitative process and lead to various psychosocial problems.
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