ABSTRACT
BACKGROUND@#China is the most populated country and the second economic entity worldwide. Hong Kong and Shenzhen are two adjacent cities in southern China, with similar environmental, cultural, ethnic groups, and economic development. They both have a very interesting turning point in their destiny, leading to a miraculous economic development. However, their government structure and health care system are totally different.[1] This is a vivid example of Deng Xiaoping's formulation of the principle of "one country, two systems".
ABSTRACT
<p><b>PURPOSE</b>To evaluate the performance of a prehospital trauma diversion system in Hong Kong, China.</p><p><b>METHODS</b>A retrospective analysis of prospectively collected data in the trauma registry of Queen Mary Hospital, Hong Kong from 1 January 2009 to 31 December 2013 was done. All adult patients aged 18 years or above, either primarily or secondarily diverted to Queen Mary Hospital according to the trauma patient diversion protocol, were recruited. Need for trauma center level of care was based on a consensus-based criterion standard published in 2014. Performance of the protocol in terms of over- diversion and under-diversion was determined.</p><p><b>RESULTS</b>A total of 209 patients were included for analysis. About 30% of the patients required trauma center level of care. The most common reason was the need for vascular, neurologic, abdominal, thoracic, pelvic, spine or limb-conserving surgery within 24 h of presentation. The over-diversion rate and under- diversion rate were 69.6% and 19.7% respectively.</p><p><b>CONCLUSION</b>The trauma patient diversion protocol currently in use in Hong Kong is not accurate enough. Further revision and refinement is needed.</p>
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Emergency Medical Services , Hong Kong , Retrospective Studies , Trauma CentersABSTRACT
<p><b>OBJECTIVE</b>Focused Abdominal Sono-graphy for Trauma (FAST) is widely used for the detection of intraperitoneal free fluids in patients suffering from blunt abdominal trauma (BAT). This study aimed at assessing the diagnostic accuracy of this investigation in a designated trauma centre.</p><p><b>METHODS</b>This was a retrospective study of BAT patients over a 6 year period seen in a trauma centre in Hong Kong. FAST findings were compared with laparotomy, abdominal computed tomography or autopsy findings, which served as the gold standard for presence of intraperitoneal free fluids. The patients who did not have FAST or gold standard confirmatory test performed, had preexisting peritoneal fluid, died at resuscitation or had imcomplete documentation of FAST findings were excluded. The performance of FAST was expressed as sensitivity, specificity, predictive values (PV), likelihood ratios (LR) and accuracy.</p><p><b>RESULTS</b>FAST was performed in 302 patients and 153 of them were included in this analysis. The sensitivity, specificity, positive PV, negative PV, positive LR, negative LR and accuracy for FAST were respectively 50.0%, 97.3%, 87.0%, 84.6%, 18.8, 0.5 and 85.0%. FAST was found to be more sensitive in less severely injured patients and more specific in more severely injured patients.</p><p><b>CONCLUSION</b>FAST is a reliable investigation in the initial assessment of BAT patients. The diagnostic values of FAST could be affected by the severity of injury and staff training is needed to further enhance its effective use. Key words: Laparotomy; Autopsy; Tomography, X-ray computed; Tomography, spiral computed; Ultrasonography.</p>