Major trauma care in Hong Kong and Germany: a trauma registry data benchmark study
Publication in refereed journal
Officially Accepted for Publication


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AbstractBackground:
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.
Acceptance Date23/01/2020
All Author(s) ListLai CY, Maegele M, Yeung JHH, Lefering R, Hung KCK, Chan PS, Leung M, Wong HT, Wong JKS, Graham CA, Cheng CH, Cheung NK
Journal nameEuropean Journal of Trauma and Emergency Surgery
Year2020
PublisherSpringer (part of Springer Nature): Springer Open Choice Hybrid Journals
ISSN1863-9933
eISSN1863-9941
LanguagesEnglish-United Kingdom
KeywordsGermany, Hong Kong, Major trauma, Mortality; Quality of trauma care, RISC II, Registry comparison, Trauma registry

Last updated on 2020-23-05 at 23:34