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

Abstract

Background: Despite the high incidence of major trauma, few studies have directly compared the performance of trauma systems. This study compared trauma system performance in Victoria, Australia, and Hong Kong, China. Methods: Prospectively collected data over 5 years from January 2001 from the two trauma systems were compared using univariate analysis. Variables were then entered into a multivariate logistic regression to assess differences in outcome between the systems, adjusted for effects of clinically important factors. Results: 5536 cases from Victoria, Australia and 580 cases from Hong Kong. The Hong Kong group was older, but mechanisms of injury were similar in both systems. Thoracic and abdominal trauma were more common in Victoria, Australia, compared with more head injuries in Hong Kong. More patients were admitted to intensive care in Victoria, Australia and patients stayed in intensive care one day longer on average, despite more co-morbidity in Hong Kong patients. Overall mortality was 20.2% for Hong Kong and 11.9% for Victoria, Australia (x2 = 32.223, p,0.001). Conclusion: The performance of the Hong Kong trauma system was comparable to international standards, but there was a significant difference in the probability of survival of major trauma between the two systems. Possible modifiable factors may include criteria for activation of trauma calls and improved intensive care unit utilisation.