Authors (including presenting author) :
Lai CY(1)(2), Maegele M(3), Yeung HHJ(1)(2), Lefering R(3), Hung KC(2), Chan PSL(4), Leung M(5), Wong HT(6), Wong KS(7), Graham CA(1)(2), Cheng CH(1)(2), Cheung NK(1)(2)
Affiliation :
(1)Accident and Emergency Department, Prince of Wales Hospital, (2)Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, (3)German Trauma Society, (4)Trauma Service, Queen Elizabeth Hospital, (5)Department of Surgery, Princess Margaret Hospital, (6)Trauma Service, Queen Mary Hospital, (7)Trauma Service, Tuen Mun Hospital
Introduction :
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. To date, no comparative study has yet been performed with respect to the performance of trauma systems in Hong Kong and Germany.
Objectives :
The aim of this study was to compare the performance of trauma care systems including outcomes among major trauma victims (defined as an injury severity score (ISS)>15) over a 3-year period (2013-2015) in Hong Kong and Germany based upon data derived from respective registries.
Methodology :
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.
Result & Outcome :
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.
Specifically addressing elderly trauma, head injury and co-morbidities, RISC II is more suitable for use in Hong Kong, as it was shown to outperform TRISS in predicting the 30-day mortality for Hong Kong adult blunt major trauma patients in a subsequent study. Since 2020, the RISC II has been introduced to the Central Committee (Trauma Service) as a tool for performing routine audits and benchmarking exercises for trauma in Hong Kong.
