Major trauma care in Hong Kong and Germany: a trauma registry data benchmark study

Lai, Chun Yu, Maegele, Marc, Yeung, Janice Hiu Hung, Lefering, Rolf, Hung, Kei Ching Kevin, Chan, Po Shan Lily, Leung, Ming, Wong, Hay Tai, Wong, John Kit Shing, Graham, Colin Alexander, Cheng, Chi Hung and Cheung, Nai Kwong . Major trauma care in Hong Kong and Germany: a trauma registry data benchmark study. Eur. J. Trauma Emerg. Surg.. HEIDELBERG: SPRINGER HEIDELBERG. ISSN 1863-9941

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DOI:10.1007/s00068-020-01311-6

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(R) (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.

Item Type:

Journal Article

Creators:

Creators	Email	ORCID	ORCID Put Code
Lai, Chun Yu	UNSPECIFIED	UNSPECIFIED	UNSPECIFIED
Maegele, Marc	UNSPECIFIED	UNSPECIFIED	UNSPECIFIED
Yeung, Janice Hiu Hung	UNSPECIFIED	UNSPECIFIED	UNSPECIFIED
Lefering, Rolf	UNSPECIFIED	UNSPECIFIED	UNSPECIFIED
Hung, Kei Ching Kevin	UNSPECIFIED	UNSPECIFIED	UNSPECIFIED
Chan, Po Shan Lily	UNSPECIFIED	UNSPECIFIED	UNSPECIFIED
Leung, Ming	UNSPECIFIED	UNSPECIFIED	UNSPECIFIED
Wong, Hay Tai	UNSPECIFIED	UNSPECIFIED	UNSPECIFIED
Wong, John Kit Shing	UNSPECIFIED	UNSPECIFIED	UNSPECIFIED
Graham, Colin Alexander	UNSPECIFIED	UNSPECIFIED	UNSPECIFIED
Cheng, Chi Hung	UNSPECIFIED	UNSPECIFIED	UNSPECIFIED
Cheung, Nai Kwong	UNSPECIFIED	UNSPECIFIED	UNSPECIFIED