Improving clinical outcome through trauma system.

• Other Authors: Yeung, Hiu Hung.
• Format: Others
• Language: English; Chinese
• Published: 2010
• Subjects: Trauma centers > Administration; Trauma centers > China > Hong Kong > Administration; Wounds and injuries > Treatment; Trauma Centers > organization & administration; Trauma Centers > organization & administration > Hong Kong; Wounds and Injuries > therapy
• Online Access: http://library.cuhk.edu.hk/record=b6075068; http://repository.lib.cuhk.edu.hk/en/item/cuhk-344701

Aim The aims of this project were to (i) evaluate whether the trauma care system established in Hong Kong has improved the survival rate among trauma patients; (ii) evaluate the effectiveness of trauma teams and their coordinators, primary trauma diversion, and performance improvement programmes, and assess the influence of gender and age on patient outcomes; and (iii) compare clinical outcomes before and after the establishment of a trauma system in Hong Kong and measure them against those achieved in an established regional trauma system in Australia. === Background Injury is a major public health problem that creates an enormous social burden. Although Hong Kong has tried to build up a trauma care system according to the criteria employed by the American College of Surgeons Committee on Trauma, there are a number of differences between the two. The effectiveness of the key components of trauma care processes and their clinical outcomes are unclear, and the final outcome in terms of survival rate is unknown. === Conclusion Proficient trauma teams, primary trauma diversion, and clinical guidelines are key components of the trauma system that contribute to improved outcomes. === Methods Retrospective analysis of data collected prospectively from the trauma registries in Hong Kong and Australia. The Trauma and Injury Severity Score (TRISS), the W score, the Z score, the M score, and Ws statistics are employed to evaluate the mortality rate. === Results The W score for Hong Kong improved significantly from - 4.79 in 1997 to 0.51 in 2009 after the trauma system was established (P<0.05). The improving trend observed in the Ws score (- 4.86 +/- SE 1.24 Vs 1.06 +/- SE 0.74) over the same period indicates that the survival rate increased from 1997 to 2009 (P < 0.01). The time taken to deliver the patient from the scene to definitive care was reduced by 97 minutes (P < 0.001) using a primary trauma diversion strategy. Proficient trauma teams are associated with reduced mortality in patients with a moderately poor probability of survival (p = 0.007) and trauma nurse coordinators play an essential role in conducting trauma audits and maintaining trauma registries. The introduction of guidelines and staff education could result in significant improvements to the trauma care process. Advancing age is associated with an increased mortality rate, whereas gender is not. Injury prevention programmes in Hong Kong are inadequate. === Yeung, Hiu Hung. === Advisers: Timothy H. Rainer; Wai Sang Poon. === Source: Dissertation Abstracts International, Volume: 73-02, Section: B, page: . === Thesis (Ph.D.)--Chinese University of Hong Kong, 2010. === Includes bibliographical references (leaves 282-328). === Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. === Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. === Abstract also in Chinese.