The impact of enhanced intensive care on outcome of major trauma patients in a regional hospital in Hong Kong

Objectives: To describe an updated epidemiology of major trauma cases presenting to a regional hospital in Hong Kong and to analyse the impact of enhanced intensive care on the outcome of major trauma patients. Methods: This was a retrospective comparative study. In late 2004, we amended our trauma care system with enhancement of intensive care in the management of major trauma patients. An 18-month period was chosen before and after the amendment respectively and patients' data and crude mortality rate between the two periods were compared. Stratified analyses based on mechanism of injury, injury severity and physiological parameters were also performed. Finally, a TRISS analysis was included. Results: Altogether 163 and 155 patients were included in our study from the two periods respectively. The majority involved blunt injury and one third of them had injury severity score (ISS) greater than 15. Road traffic accidents and fall from height remained as the two leading causes of major trauma. The median length of stay in the intensive care unit increased for one day (p<0.01) in the later period but the median total length of stay in hospital remained the same. The mortality rate decreased from 10.4% to 9.7% (p=0.82). Conclusion: With enhanced intensive care, there is an apparent decrease in mortality of major trauma patients but its significance needs to be determined with a larger scale study. (Hong Kong j.emerg.med. 2008;15:218-229)