Five year analysis of Jockey Club horse-related injuries presenting to a trauma centre in Hong Kong

BACKGROUND: Professional horse riding-related injuries have not been studied before in Hong Kong, although horse racing takes place very regularly in the territory. In addition, the equestrian events of the 2008 Beijing Olympic Games will come to Hong Kong. This study analysed the pattern of horse-related injury among patients who presented to a trauma centre in a teaching hospital in Hong Kong. METHODS: Information from the trauma centre database was analysed retrospectively. The database includes trauma patients who had sustained potentially severe injuries that warranted initial assessment and resuscitation in a trauma resuscitation room (triage category 1 or 2). Data analysed included demographic variables, causes and mechanisms of injury, anatomical injuries, anatomical and physiological trauma scores, and patient outcome. RESULTS: Between January 2001 and June 2005, 2312 trauma patients were entered into the database. Thirty-six (1.6%) patients had sustained horse-related injuries (mean age 34 years, range 17-54; male to female ratio 32:4), all whilst at work in the Jockey Club. Twenty-two patients were injured between midnight and 09:00 h. This group stayed in the resuscitation room for longer prior to admission compared with patients presenting between 09:00h and midnight (median time 127 min (interquartile range [IQR] 57-183) versus 58 min (IQR 43-83), p=0.06). Twenty-five patients fell from horseback, whilst 11 were kicked by the horse. Twenty patients had a single injury and 16 patients had multiple injuries. Eighteen patients had injuries to the thorax, abdomen, thoracolumbar spine or pelvis. Eleven patients had head, face and cervical spine injuries and 11 had limb injuries. Twenty-five patients were admitted, including four admitted to the intensive care unit (ICU). Ten patients required surgery. Median (standard deviation [S.D.]) probability of survival was 0.996 (0.052) and median revised trauma score (RTS) (S.D.) was 7.841 (0.624). There were no fatalities. Potentially serious horse-related injuries presented once every 6 weeks. CONCLUSION: Most injuries are minor and affect the trunk but occur out of hours. Helmets, face shields and body protectors should be worn when riding or handling horses.     

Primary trauma diversion: initial experience in Hong Kong

BACKGROUND: Trauma is a leading cause of death and loss of workdays in Hong Kong. Reports have suggested that timely provision of care in dedicated trauma centers can improve outcomes. Until recently, ambulances were required to take trauma patients to the nearest hospital's emergency department. This paper reports on the initial experience of primary trauma diversion from scene to a dedicated trauma center in Hong Kong. METHODS: This prospective study involved the establishment of primary trauma diversion in the area served by Alice Ho Nethersole Hospital (AHNH), a general hospital in the New Territories. Trauma patients who fulfilled diversion criteria were taken directly to the Prince of Wales Hospital (PWH) in Shatin, a university teaching hospital and trauma center for the area. Data were collected to determine the change in time to definitive care for trauma patients and an impact analysis on PWH services was performed. RESULTS: There were 60 patients who underwent primary trauma diversion and 35 patients underwent secondary diversion after initial treatment at AHNH. This represented two extra trauma patients per week at PWH. Median Injury Severity Score (ISS) was 9 and 52% of patients had been involved in a traffic crash. Of eligible patients, 76% (69 out of 91) diverted correctly according to protocol. Primary trauma diversion patients reached definitive care 97 minutes faster than patients undergoing secondary diversion. CONCLUSION: Primary trauma diversion is feasible in Hong Kong and means that patients reach definitive care 97 minutes faster than going to the nearest hospital. Primary trauma diversion protocols should be extended throughout Hong Kong.     

Trauma system in Hong Kong

The presence of a regionalized trauma system has been shown to improve outcome in trauma. Trauma care has undergone significant changes in Hong Kong in recent years. In 2003, five public hospitals were designated as trauma centres. Since then, there has been a progressive improvement in trauma patient outcome in Hong Kong. Trauma centre designation by itself, however, does not constitute a trauma system. The latter is an integration of prehospital care, interhospital transfer, trauma centres, rehabilitation, prevention, education and research. Under the primary trauma diversion policy, trauma patients in Hong Kong are no longer sent to the nearest hospitals, but transferred directly to trauma centres where definitive care can be implemented earlier. The present article describes some of these changes and addresses issues pertinent to the future development of trauma service in Hong Kong.     

Bicycle related injuries presenting to a trauma centre in Hong Kong

Background

Bicycle riding is a popular leisure activity and an important means of transportation in Hong Kong. Young cyclists’ riding behaviour causes injury patterns which may differ from older riders. The aim of this study is firstly to describe bicycle related injuries presenting to a regional trauma centre in Hong Kong, and secondly to compare patients aged >15 years with those patients aged ≤15 years.

Methods

This retrospective observational study examined all bicycle related injury patients presenting to the ED of the Prince of Wales Hospital (PWH) in 2006.

Results

Results showed that bicycle helmet use was low in Hong Kong suggesting that the wearing of helmets when cycling should be promoted. Bicycle related injuries were common in children but the injuries in adults were more serious. Head and limb injuries were common and limbs on the left side were 2.5 times more likely to be injured than those on the right. The older group were more likely to be involved in a motor vehicle collision and sustained more severe injuries than the younger group. They had more serious head and neck, face, thorax and abdominal injuries compared to the younger group.

Conclusion

Prevention strategies should include more widespread helmet use and increasing bicycle lane provision to enable traffic separation in Hong Kong. The three ‘E’ approaches (education, enforcement and environment) should be implemented to prevent bicycle injuries in Hong Kong.     

Current trauma care system and trauma care training in China

Trauma is a life-threatening “modern disease”. The outcomes could only be optimized by cost-efficient and prompt trauma care, which embarks on the improvement of essential capacities and conceptual revolution in addition to the disruptive innovation of the trauma care system. According to experiences from the developed countries, systematic trauma care training is the cornerstone of the generalization and the improvement on the trauma care, such as the Advance Trauma Life Support (ATLS). Currently, the pre-hospital emergency medical services (EMS) has been one of the essential elements of infrastructure of health services in China, which is also fundamental to the trauma care system. Hereby, the China Trauma Care Training (CTCT) with independent intellectual property rights has been initiated and launched by the Chinese Trauma Surgeon Association to extend the up-to-date concepts and techniques in the field of trauma care as well to reinforce the generally well-accepted standardized protocols in the practices. This article reviews the current status of the trauma care system as well as the trauma care training.     

香港地区骨科发展历程

Hodgson教授在1951年抵港，开始了骨科发展史的首页，骨痨的清创及前路脊柱融合术令香港世界知名。随后，骨科迅速发展，先后在13家大医院开设骨科部门；资深医生改为私人执业，建立了强大的私人市场。目前全港有约380名骨科专家或在职受训医生，超过2450张急诊骨科床及多张复康床。香港骨科医学会是一群紧密联系的医生及治疗师的组织。香港骨科医学院则负责国际认可的专业考试，举办训练，持续进修。如此能确保香港骨科的迅速发展在未来将会继续。     

Women surgeons in Hong Kong

Objective: To survey Hong Kong women surgeon's current situation: their ability to balance career, personal and family life, and to look into some gender-specific issues. Methods: A 28-item questionnaire online survey was emailed to 142 female and 761 male surgeons with questions asking about four areas: demographic data, job satisfaction, work life balance and work opportunity. Results: Fifty-eight female and 114 male surgeons completed the questionnaire. The mean age of female surgeon respondents was significantly younger than male surgeon respondents (33 vs 43 years, P < 0.001). Both female and male surgeons worked long hours (70% female and 64% male worked >= 60 hours per week, P = 0.402); however, both felt satisfied or very satisfied with their current job situation (74% female and 76% male, P = 0.536) and were happy or very happy with other aspects of their lives (84% female and 82% male). More male respondents were married (83% male vs 35 % female, P < 0.001) and more married men had biological children at the time of the survey (83% male vs 62% female, P = 0.034). Both married males and females had family commitments affecting training, career advancement and overseas training. The majority of male and female surgeons did not experience discrimination during training or career advancement; however, more females felt discriminated against during selection and training processes (25% female vs 12% male, P = 0.001) and during career advancement (18% female vs 10% male, P = 0.013). Conclusion: Our survey results showed that both female and male surgeons are able to combine productive careers with satisfactory personal and family lives. However, both female and male surgeons faced many difficulties in their working lives; women may have more difficulties regarding family issues, as our survey showed that more women surgeons remained single and more married women surgeons had no children. Policies that facilitate a work life balance are important to attract and retain the best and talented physicians, regardless of sex. In view of the increasing number of women surgeons, frequent surveys are needed to determine whether women surgeons experience a working environment that ensures a level playing field.     

Evaluation of a tiered trauma call system in a level 1 trauma centre

Background

Appropriate triage of the trauma patient is essential to ensure prompt access to definitive care. Many trauma centres use a “tiered” trauma call protocol with the intention of providing a match between the facility's resources and the needs of the patient. This study describes the incidence and impact of undertriage on the trauma patient in the context of an Australian level 1 trauma centre with a tiered trauma call system.

Methods

This was a retrospective analysis of prospective data collected through the Trauma Registry. Undertriage was defined as sustaining an injury severity score greater than 15 and receiving a non-optimal response (i.e., trauma standby call or no call). The level of association between outcome measures (such as LOS in ED, time to OT) and the level of trauma call the patient received was assessed using a general linear model, controlling for injury severity and haemodynamic stability.

Results

Between February 2004 and November 2008, 5233 patients meeting trauma criteria presented to the study hospital. There was an undertriage rate of 42% and overtriage rate of 21%. Patients were more likely to be undertriaged if they were older, self-presented, their cause of injury was assault or their head or chest were their most severely injured body region. Undertriaged patients had a significantly longer LOS in the ED (2 h) than appropriately triaged patients.

Conclusion

The implementation of a tiered trauma call system resulted in significant undertriage, especially if the patient was older, had been assaulted or had a head/chest injury. Undertriaged patients experienced delay to definitive care. This study has highlighted the importance of compliance with trauma team activation criteria, trauma monitoring and evaluation.     

香港地区动脉瘤的治疗现状

目的 阐述香港动脉扩张性疾病的流行病学模式及主动脉瘤传统手术与腔内治疗术的发展现状。方法 分析香港医院管理局1999－2000年主动脉瘤统计数值,香港血管外科工作小组在公立医院主动脉瘤调查报告及香港大学外科学系血管外科833例患者经验。结果 主动脉瘤是香港地区目前第10大致命疾病,每年大概发现800例新病例,而主动脉瘤破裂率为10％,破裂病死率为80％。目前一半手术适应证为主动脉瘤破裂,有大比例患者未获手术治疗。在有经验的血管外科中心腹主动脉瘤择期手术病死率已下降至2％,而破裂手术病死率也降低为38％。结论 香港地区主动脉瘤发病率与世界发病率同步增加。近年腔内治疗术迅速发展,有一定的成效,但患者选择与随访至为重要。     

Current state and future perspectives of trauma care system in mainland China

Objective

To investigate the current state of trauma care in mainland China, and to propose possible future suggestions for the development of the trauma care system in mainland China.

Method

An extensive Medline/PubMed search on the topic of trauma care or trauma care system was conducted. Publications in Chinese that could best describe the state of trauma care in China were also included. In addition, two meetings were held by Group for Trauma Emergency Care and Multiple Injuries, Trauma Society of Chinese Medical Association to discuss the development and perspectives of trauma care system in mainland China. Important conclusions from the two meetings were included in this publication.

Results

Trauma has become an increasing public health problem in mainland China in association with the rapid growth of the economy over the past 30 years. Although great progress has been made in regards to the care of the injured, there is still no government agency dedicated to deal with trauma-related issues, or a national trauma care system operating on the Chinese mainland. Various trauma prevention measures have been taken, but with little effect. Funds contributed to trauma-related research has increased in recent years and promoted rapid development in this field, but further improvement in research is needed. However, many groups such as the Trauma Society of the Chinese Medical Association have continued to explore mechanisms for the treatment of trauma patients and have developed various types of regional trauma care systems, resulting in improved trauma care and a better outcome for the injured.

Conclusions

Although great progress has been made in trauma care in mainland China, there are many failings. To improve trauma care in China, the establishment of a sophisticated trauma system and various enhancements on trauma prevention are urgently required.     

Trauma care systems: a comparison of trauma care in Victoria, Australia, and Hong Kong, China

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.     

Improving outcomes in a regional trauma system: impact of a level III trauma center

BACKGROUND: Trauma systems decrease morbidity and mortality of injured populations, and each component contributes to the final outcome. This study evaluated the association between a referring hospital's trauma designation and the survival and resource utilization of patients transferred to a level I trauma center. METHODS: Data from the Registry of the American College of Surgeons on patients transferred to a level I trauma center during a 7-year period were subdivided into 3 categories: group 1 = level III-designated trauma center; group 2 = potential level III trauma centers; and group 3 = other transferring hospitals. Trauma and Injury Severity Score methodology was used to provide a probability estimate of survival adjusted for the effect related to injury severity, physiologic host factors, and age. A W statistic was calculated for each type of referring hospital so that comparisons between observed survival and predicted survival could be measured. Differences in W, length of stay, intensive care unit days, and ventilator days were examined using general linear models. RESULTS: Patients transferred to a level I from a level III trauma center (group 1) were more seriously injured (P < .0001) and had improved survival (P < .0018) compared with those transferred from nondesignated hospitals (groups 2 and 3). Patients transferred from large nondesignated hospitals (group 2) had outcomes similar to patients transferred from all other hospitals (group 3). Level I hospital resource utilization did not show significant differences based on referring hospital type. COMMENTS: Outcomes of patients in a trauma system are associated with trauma-center designation of the referring hospitals.     

Depression and lower urinary tract symptoms: Two important correlates of erectile dysfunction in middle-aged men in Hong Kong, China

AIM: To evaluate the correlates of erectile dysfunction (ED) in Hong Kong middle-aged Chinese men aged 45-64 years. METHODS: A community-based cross-sectional household survey was performed in Hong Kong. The Chinese abridged version of the International Index of Erectile Function (IIEF-5) was used to measure erectile function. The International Prostate Symptom Score (IPSS) was used to measure lower urinary tract symptoms (LUTS) and depressive symptoms were measured by the Center for Epidemiological Studies Depression Scale (CES-D). Demographic and lifestyle data were also collected. The association between ED and its correlates was analyzed using bivariate and multivariate analyses. RESULTS: Of the 545 subjects who agreed to participate in the survey, 75 refused to answer questions about their sexual activities and function. Out of those who responded, 118 (22%) subjects were not sexually active (not sexually active over the past 4 weeks). Out of 352 subjects, 60.3% suffered from some degree of ED. Age, presence of depression defined by CES-D and moderate LUTS were associated with increased odds of having ED. In multivariate analysis, depressive symptoms identified by CES-D (OR = 2.3, CI: 1.2-4.6) and moderate LUTS (OR = 3.7, CI: 1.6-8.3) were independently associated with increased odds of having ED. CONCLUSION: ED is an important public health problem in Chinese middle-aged men, with more than half suffering from some degree of ED. Depression and LUTS were significant and important risk factors associated with ED.     

Changing epidemiology of osteoporotic hip fracture rates in Hong Kong

Summary This study analyses the trend in hip fracture incidence in Southern Chinese in Hong Kong. The results show that the age-adjusted incidence has stabilized in recent years. Among subjects aged 50–59 years, a declining fracture rate is observed. Increasing awareness and a healthier ageing population could partly explain this improvement. Introduction Studies published in the early 1990s projected that half of the world’s hip fractures would occur in Asia, mostly in China, by 2050. Whether this prediction will become a reality is not clear. This study was conducted to determine the incidence (per 100,000 persons) of hip fracture in Southern Chinese subjects ≥50 years in Hong Kong between 1995 and 2004 and compare them with the fracture rates during the previous 30 years in order to help predict the impact on future public health services in Hong Kong. Methods Data were obtained from the Clinical Data Analysis Reporting System (CDAS) of the Hospital Authority of Hong Kong. Results The age-specific incidence of hip fracture showed a downward trend in subjects aged 50–59 years in both sexes, but remained stable for other age-groups. Plateauing and declining fracture rates were observed when compared with previous reports of a more than twofold increase in incidence of hip fractures from the 1960s to 1980s in Hong Kong. The exact reasons for this improvement are unclear, but a cohort effect towards healthier ageing and increasing awareness of osteoporosis among the adult population in Hong Kong is considered as a possible factor.     

Definitive airway management after prehospital supraglottic rescue airway in pediatric trauma

Introduction

Supraglottic airway (SGA) use and outcomes in pediatric trauma are poorly understood. We compared outcomes between patients receiving prehospital SGA versus bag mask ventilation (BVM).

Performance comparison of improvised prehospital blood warming techniques and a commercial blood warmer

IntroductionPrehospital transfusion of packed red blood cells (PRBC) may be life saving for hypovolaemic trauma patients. PRBCs should preferably be warmed prior to administration but practical prehospital devices have only recently become available. The effectiveness of purpose designed prehospital warmers compared with previously used improvised methods of warming has not previously been described.Materials and methodsExpired units of PRBCs were randomly assigned to a warming method in a bench study. Warming methods were exposure to body heat of an investigator, leaving the blood in direct sunlight on a dark material, wrapping the giving set around gel heat pads or a commercial fluid warmer (Belmont Buddy Lite). Methods were compared with control units that were run through the fluid circuit with no active warming strategy.ResultsThe mean temperature was similar for all methods on removal from the fridge (4.5 °C). The mean temperatures (degrees centigrade) for all methods were higher than the control group at the end of the circuit (all P ≤ 0.001). For each method the mean (95% CI) temperature at the end of the circuit was; body heat 17.2 (16.4–18.0), exposure to sunlight 20.2 (19.4–21.0), gel heat pads 18.8 (18.0–19.6), Buddy Lite 35.2 (34.5–36.0) and control group 14.7 (13.9–15.5).ConclusionsAll of the warming methods significantly warmed the blood but only the Buddy Lite reliably warmed the blood to a near normal physiological level. Improvised warming methods therefore cannot be recommended.     

Trajectory of functional outcome and health status after moderate-to-major trauma in Hong Kong: A prospective 5 year cohort study

BackgroundTrauma care systems in Asia have been developing in recent years, but there has been little long-term outcome data from injured survivors. This study aims to evaluate the trajectory of functional outcome and health status up to five years after moderate to major trauma in Hong Kong.MethodsWe report the five year follow up results of a multicentre, prospective cohort from the trauma registries of three regional trauma centres in Hong Kong. The original cohort recruited 400 adult trauma patients with ISS ≥ 9. Telephone follow up was conducted longitudinally at seven time points, and the extended Glasgow Outcome Scale (GOSE) and Short-Form 36 (SF36) were tracked.Results119 out of 309 surviving patients (39%) completed follow up after 5 years. The trajectory of GOSE, PCS and MCS showed gradual improvements over the seven time points. 56/119 (47.1%) patients reported a GOSE = 8 (upper good recovery), and the mean PCS and MCS was 47.8 (95% CI 45.8, 49.9) and 55.8 (95% CI 54.1, 57.5) respectively at five years. Univariate logistic regression showed change in PCS - baseline to 1 year and 1 year to 2 years, and change in MCS - baseline to 1 year were associated with GOSE = 8 at 5 years. Linear mixed effects model showed differences in PCS and MCS were greatest between 1-month and 6-month follow up.ConclusionsAfter injury, the most rapid improvement in PCS and MCS occurred in the first six to 12 months, but further recovery was still evident for MCS in patients aged under 65 years for up to five years.