title: The first 5 years since trauma center designation in the Hong Kong Special Administrative Region, People's Republic of China.
abstract: BACKGROUND
  In 1994, the Hong Kong Special Administrative Region (HKSAR) introduced plans to implement a trauma system based on the recommendations outlined by Professor Donald Trunkey in his report to the local Hospital Authority. Five government-subsidized public hospitals were subsequently designated as trauma centers in 2003. This article reviews the initial experience in these five centers.
  
  
  METHODS
  Prospective trauma registries from January 2004 to December 2008 were reviewed. Primary clinical outcome measures were hospital mortality. The Trauma and Injury Severity Score methodology was used for benchmarking with the Major Trauma Outcome Study (MTOS) database.
  
  
  RESULTS
  The majority (83.3%) of the 10,462 patients suffered from blunt trauma. Severe injury, defined as Injury Severity Score>15, occurred in 29.7% of patients. The leading causes of trauma were motor vehicle collisions and falls, with crude hospital mortality rates of 6.9% and 10.7%, respectively. The M-statistic was 0.95, indicating comparable case-mix with the MTOS. The worst outcome occurred in the first year. Significant improvement was seen in patients with penetrating injuries. By 2008, these patients had significantly higher survival rates than expected (Z-statistic=0.85). Although the overall mortality rates for blunt trauma were higher than expected, the difference was no longer statistically significant from the second year onward.
  
  
  CONCLUSIONS
  The case-mix of trauma patients in the HKSAR is comparable with that of the MTOS. A young trauma system relatively unburdened by dissimilar reimbursement and patient access issues may achieve significant improvement and satisfactory patient outcomes. Our findings may serve as a useful benchmark for HK and other Southeast Asian cities and trauma systems to establish local coefficients for future evaluations.
authors.affiliation: Hospital Authority Central Committee, Trauma service, The Hospital Authority, Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China. gilberto@hkucc.hku.hk
authors.forename: Gilberto Ka Kit
authors.initials: GK
authors.lastname: Leung
authors.forename: Annice
authors.initials: A
authors.lastname: Chang
authors.forename: F C
authors.initials: FC
authors.lastname: Cheung
authors.forename: H F
authors.initials: HF
authors.lastname: Ho
authors.forename: Wendy
authors.initials: W
authors.lastname: Ho
authors.forename: S M
authors.initials: SM
authors.lastname: Hui
authors.forename: C W
authors.initials: CW
authors.lastname: Kam
authors.forename: Albert
authors.initials: A
authors.lastname: Lai
authors.forename: K W
authors.initials: KW
authors.lastname: Lam
authors.forename: M
authors.initials: M
authors.lastname: Leung
authors.forename: S H
authors.initials: SH
authors.lastname: Liu
authors.forename: C B
authors.initials: CB
authors.lastname: Lo
authors.forename: Francis
authors.initials: F
authors.lastname: Mok
authors.forename: Timothy H
authors.initials: TH
authors.lastname: Rainer
authors.forename: W Y
authors.initials: WY
authors.lastname: Shen
authors.forename: F L
authors.initials: FL
authors.lastname: So
authors.forename: Gordon
authors.initials: G
authors.lastname: Wong
authors.forename: Amy
authors.initials: A
authors.lastname: Wu
authors.forename: Janice
authors.initials: J
authors.lastname: Yeung
authors.forename: W K
authors.initials: WK
authors.lastname: Yuen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D006285:Health Planning; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries / Q000706:statistics & numerical data*; D014193:Trauma Centers / Q000458:organization & administration*; D015599:Trauma Severity Indices; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D055815:Young Adult