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

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

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® (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.

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Author information

Authors and Affiliations

  1. Accident and Emergency Department, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, The New Territories, Hong Kong

    Chun Yu Lai, Janice Hiu Hung Yeung, Kei Ching Kevin Hung, Colin Alexander Graham, Chi Hung Cheng & Nai Kwong Cheung

  2. Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, The New Territories, Hong Kong

    Chun Yu Lai, Janice Hiu Hung Yeung, Kei Ching Kevin Hung, Colin Alexander Graham, Chi Hung Cheng & Nai Kwong Cheung

  3. Department of Trauma and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC), University Witten/Herdecke (UW/H), Campus Cologne-Merheim, Ostmerheimerstr. 200, 51109, Cologne, Germany

    Marc Maegele & Rolf Lefering

  4. Insitute for Research in Operative Medicine (IFOM), University Witten/Herdecke (UW/H), Campus Cologne-Merheim, Ostmerheimerstr. 200, 51109, Cologne, Germany

    Marc Maegele & Rolf Lefering

  5. Trauma Service, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong

    Po Shan Lily Chan

  6. Department of Surgery, Princess Margaret Hospital, 2-10 Princess Margaret Hospital Road, Lai Chi Kok, Kowloon, Hong Kong

    Ming Leung

  7. Trauma Service, Queen Mary Hospital, 102 Pok Fu Lam Road, Hong Kong Island, Hong Kong

    Hay Tai Wong

  8. Trauma Service, Tuen Mun Hospital, 23 Tsing Chung Koon Road, Tuen Mun, The New Territories, Hong Kong

    John Kit Shing Wong

Authors
  1. Chun Yu Lai
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  2. Marc Maegele
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  3. Janice Hiu Hung Yeung
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  4. Rolf Lefering
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  5. Kei Ching Kevin Hung
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  6. Po Shan Lily Chan
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  7. Ming Leung
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  8. Hay Tai Wong
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  9. John Kit Shing Wong
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  10. Colin Alexander Graham
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  11. Chi Hung Cheng
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  12. Nai Kwong Cheung
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Corresponding author

Correspondence to Marc Maegele.

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Conflict of interest

Rolf Lefering declares that his institution receives an ongoing support from the AUC GmbH (owner of the TraumaRegister DGU®) which includes the statistical support for scientific analyses. All other authors declare no conflict of interest.

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Lai, C.Y., Maegele, M., Yeung, J.H.H. et al. Major trauma care in Hong Kong and Germany: a trauma registry data benchmark study. Eur J Trauma Emerg Surg 47, 1581–1590 (2021). https://doi.org/10.1007/s00068-020-01311-6

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  • DOI: https://doi.org/10.1007/s00068-020-01311-6

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