[show abstract][hide abstract] ABSTRACT: Observational studies on injured patients requiring massive transfusion have found a survival advantage associated with use of equivalent number of units of fresh frozen plasma (FFP) and packed red blood cells (RBCs) compared with use of FFP based on conventional guidelines. However, a survivorship bias might have favoured the higher use of FFP because patients who died early never had the chance to receive sufficient FFP to match the number of RBC units transfused.
A Markov model using trauma data from local hospitals was constructed and various FFP transfusion scenarios were applied in Monte Carlo simulations in which the relative risk of death associated with exposure to high FFP transfusion was set at 1.00, so that the FFP : RBC ratio had no influence on mortality outcome.
Simulation results showed that the relative risk associated with exposure to high FFP transfusion was less than 1.00 (0.33-0.56 based on programmed delays in achieving an FFP : RBC ratio of 1 : 1-2), thus demonstrating a survivorship bias in favour of FFP : RBC equal to or more than 1 : 1-2 in certain observational trauma studies. This bias was directly proportional to the delay in achieving a FFP : RBC ratio of 1 : 1-2 during resuscitation.
Some observational studies comparing low and high FFP administration in injured patients requiring massive transfusion probably involve survivorship bias that inflates or creates a survival advantage in favour of a higher FFP : RBC ratio.
British Journal of Surgery 01/2012; 99 Suppl 1:132-9. · 4.84 Impact Factor
[show abstract][hide abstract] ABSTRACT: Head injury is the leading cause of death in patients with major trauma, but little is known of post-trauma rehabilitation morbidity in Hong Kong. The purpose of this study was to identify factors affecting functional outcome in hormonally active patients 6 months after head injury.
Secondary analysis of the trauma registry database with data collected prospectively at two trauma centres between January 2001 and December 2007. Demographic and trauma data for patients aged 12-45 years with a head Abbreviated Injury Score ≥3 were analysed. The Glasgow outcome scale (GOS) was used for assessment and was assessed 6 months after head injury. The primary outcome measure was a composite poor outcome, namely "dead, vegetative and severely disabled" measured using the GOS.
Of 698 patients included in the study (mean age 29 years; range 12-45 years; 75.8% male), 581 (83.2%) had a good outcome, and 117 (16.8%) met the primary outcome measure, namely a poor outcome, including 88 (12.6%) patients who died. 453 (64.9%) patients had an injury severity score (ISS) of 16-40, and 102 (14.6%) patients had an ISS>40. 220 (31.5%) patients underwent head injury related operation. The mean length of stay in the intensive care unit (ICU) was 3.9 days. Univariate analysis showed that high ISS, Emergency Department (ED) systolic blood pressure (SBP)>160mmHg or <90mmHg, respiratory rate<12/min or >24/min, low ED Glasgow Coma Score (GCS), trauma call activation, head related operation and ICU admission were related to poor outcome. Multivariate analysis showed that high ISS, low or high ED SBP and low ED GCS were related to poor functional outcome.
This study showed that ISS, ED SBP and ED GCS were related to poor functional outcome. Gender showed no statistically significant relationship with functional outcome.
[show abstract][hide abstract] ABSTRACT: Background: Trauma is one of the leading causes of death for all ages in Hong Kong. In 2003, the Hospital Authority designated five hospitals as trauma centres. Five Trauma Nurse Coordinators (TNCs) were employed to facilitate multidisciplinary care and to coordinate all aspects of quality improvement for injured patients. The present paper investigates the characteristics and roles of TNCs in Hong Kong.Methods: A questionnaire was developed and sent to all TNCs in HK to ascertain information about demographic characteristics, education, job training, roles and the TNCs’ position within the organizational structure.Results: The TNCs were 30–40 years of age (four females); are experienced registered graduate nurses; hold post-registration certificates or diplomas in emergency/critical care; and have 11–18 years nursing experience. All TNCs have pursued masters degrees, with two completed. Four of the TNCs had received formal training on computerized data management, abbreviated injury scale coding and trauma nurse coordination. TNCs averaged 2.5 years experience in their post. TNCs manage the trauma registry, are involved in clinical patient management, quality assurance activities, professional and public education and research.Conclusion: TNCs play an important role in trauma management in Hong Kong.
Surgical Practice 07/2006; 10(3):97 - 101. · 0.11 Impact Factor