Ann Surg. 2008 Feb;247(2):335-42.
Cheng CH, Graham CA, Gabbe BJ, Yeung JH, Kossmann T, Judson RT, Rainer TH,
Cameron PA.
Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong,
Trauma and Emergency Centre, Prince of Wales Hospital, Shatin, New Territories,
Hong Kong SAR, China. cx1662@gmail.com
BACKGROUND: Despite the high incidence of major trauma, few studies have directly
compared the performance of trauma systems. This study compared the trauma system
performance in Victoria, Australia, (VIC) and Hong Kong, China (HK). METHODS:
Prospectively collected data over 5 years from January 2001 from the 2 trauma
systems were compared using univariate analysis. Variables were then entered into
a multivariate logistic regression to assess differences in outcome between the
systems and adjusted for effects of clinically important factors. RESULTS: Five
thousand five thirty-six cases from VIC and 580 cases from HK were taken for
analysis. The HK group was older, but mechanisms of injury were similar in both
systems. Thoracic and abdominal trauma was more common in VIC, compared with more
head injuries in HK. More patients were admitted to intensive care in VIC and
patients stayed in intensive care 1 day longer on average, despite more
comorbidity in HK patients. Overall mortality was 20.2% for HK and 11.9% for VIC
(X(2)(1) = 32.223, P < 0.001). CONCLUSION: The performance of the HK trauma
system was comparable to international standards, but there was a significant
difference in the probability of survival of major trauma between the 2 systems.
Possible modifiable factors may include criteria for activation of trauma calls
and improved ICU utilization.