F.L. So

Tuen Mun Hospital, Hong Kong, Hong Kong

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Publications (14)17.23 Total impact

  • Y.C. Li · N.N. Sze · S.C. Wong · Wei Yan · K.L. Tsui · F.L. So
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    ABSTRACT: Method: A double-blind experimental study was conducted to evaluate the effects of alcohol impairment on the driving performance of 52 Chinese participants using a driving simulator. A series of simulated driving tests covering two driving modules, including emergency braking (EB) and following braking (FB), at 50km/h and 80km/h were performed. Linear mixed models were established to evaluate driving performance in terms of braking reaction time (BRT), the standard deviation of lateral position (SD-LANE), and the standard deviation of speed (SD-SPEED). Results: Driving performance in terms of BRT and SD-LANE was highly correlated with the level of alcohol consumption, with a one-unit increase in breath alcohol concentration (BrAC) degrading BRT and SD-LANE by 0.3% and 0.2%, respectively. Frequent drinkers generally reacted faster in their BRT than less-frequent drinkers and non-drinkers by 10.2% and 30.6%, respectively. Moreover, alcohol impairment had varying effects on certain aspects of the human control system, and automatic action was less likely to be affected than voluntary action from a psychological viewpoint. Conclusion: The findings should be useful for planning and developing effective measures to combat drink driving in Chinese communities.
    No preview · Article · Jan 2016 · Accident; analysis and prevention
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    ABSTRACT: Trauma care systems aim to reduce both death and disability, yet there is little data on post-trauma health status and functional outcome. To evaluate baseline, discharge, six month and 12 month post-trauma quality of life, functional outcome and predictors of quality of life in Hong Kong. Multicentre, prospective cohort study using data from the trauma registries of three regional trauma centres in Hong Kong. Trauma patients with an ISS≥9 and aged≥18 years were included. The main outcome measures were the physical component summary (PCS) score and mental component summary (MCS) scores of the Short-Form 36 (SF36) for health status, and the extended Glasgow Outcome Scale (GOSE) for functional outcome. Between 1 January 2010 and 31 September 2010, 400 patients (mean age 53.3 years; range 18-106; 69.5% male) were recruited to the study. There were no statistically significant differences in baseline characteristics between responders (N=177) and surviving non-responders (N=163). However, there were significant differences between these groups and the group of patients who died (N=60). Only 16/400 (4%) cases reported a GOSE≥7. 62/400 (15.5%) responders reached the HK population norm for PCS. 125/400 (31%) responders reached the HK population norm for MCS. If non-responders had similar outcomes to responders, then the percentages for GOSE≥7 would rise from 4% to 8%, for PCS from 15.5% to 30%, and for MCS from 31% to 60%. Univariate analysis showed that 12-month poor quality of life was significantly associated with age>65 years (OR 4.77), male gender (OR 0.44), pre-injury health problems (OR 2.30), admission to ICU (OR 2.15), ISS score 26-40 (OR 3.72), baseline PCS (OR 0.89), one-month PCS (OR 0.89), one-month MCS (OR 0.97), 6-month PCS (OR 0.76) and 6-month MCS (OR 0.97). For patients sustaining moderate or major trauma in Hong Kong at 12 months after injury<1 in 10 patients had an excellent recovery, ≤3 in 10 reached a physical health status score≥Hong Kong norm, although as many as 6 in 10 patients had a mental health status score which is≥Hong Kong norm.
    Full-text · Article · Nov 2013 · Injury
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    CY Wong · CT Lui · FL So · KL Tsui · YH Tang
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    ABSTRACT: Introduction: Primary trauma diversion (PTD) enables direct transfer of major trauma patients to trauma centres for definitive care. This study aimed to evaluate the performance of PTD in the New Territories West Cluster (NTWC) of Hospital Authority and to identify the predictors for under-diversion. Methods: A cross-sectional study based on local trauma registry. All major trauma patients (defined as ISS15 or requiring trauma team activation) in the catchment area of the local hospital from September 2007 to December 2011 were included. The appropriateness of diversion decision was independently evaluated by an expert team (a trauma nurse coordinator and an emergency medicine practitioner). The sensitivity, specificity, predictive values, agreement, over-diversion and under-diversion rates were calculated. Potential predictors for under-diversion including age, Glasgow Coma Scale, mechanism of injury, injured body part, and the distance from scene to the trauma centre/local hospital were employed for logistic regression analysis. Results: There were 141 eligible cases identified. The sensitivity and specificity for PTD were 59.5% and 96.5% respectively. The over-diversion rate was 3.5% and the under-diversion rate was 40.5%. The overall accuracy was around 74.5%. Non-motor vehicle accident (OR 13, 95% confidence interval [CI]=3.5-48.0, p<0.01) and isolated head injury (OR 5.35, 95% CI=1.5-19.5, p=0.01) were 2 independent predictors for under- diversion in PTD. Conclusions: The overall field triage compliance by the paramedics is satisfactory. Under- diversion rate in NTWC is high. Non-motor vehicle accident mechanism and isolated head injury are 2 significant predictors for under-diversion. Reinforcement in training to avoid potential pitfalls would improve the paramedics' trauma triage performance.
    Full-text · Article · Sep 2013 · Hong Kong Journal of Emergency Medicine
  • Y.C. Li · N.N. Sze · S.C. Wong · K.L. Tsui · F.L. So
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    ABSTRACT: Introduction: Driving under the influence of alcohol (DUIA) is an important contributor to road crashes, injuries, and fatalities. Legal limits on drivers' breath alcohol concentration (BrAC) were first introduced in Hong Kong during the 1990s. Since then, the number of alcohol-related crashes has decreased. In 2009, police were empowered to conduct random breath tests (RBT) at roadblocks at any time. The availability of comprehensive RBT data allows us to determine the relationship between crash risk and BrAC, while controlling for confounding factors such as temporal distribution, road environment, and traffic conditions. Method: In this study, we established two negative binomial regression models to analyse the risk of crashes in which people are killed or seriously injured (KSI crashes) and those involving only slight injuries on 182 urban road segments. Results: Our results indicated that a higher mean BrAC markedly increases the risk of KSI crashes. However, there was no relationship between the risk of crashes involving slight injury and mean BrAC, although the absence of a hard shoulder, the presence of roadside parking bays, the dawn period, and the location noticeably increase the risk of these crashes. Conclusion: It is worth exploring the benefits of remedial measures if comprehensive information on demographics and the driving habits of individual drivers become available in the future.
    No preview · Article · May 2013 · Hong Kong Journal of Emergency Medicine

  • No preview · Article · Aug 2012 · Hong Kong medical journal = Xianggang yi xue za zhi / Hong Kong Academy of Medicine
  • C.-W. Kam · T.C.-L. Lau · F.-L. So
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    ABSTRACT: Intimate partner violence (IPV) has a high incidence in the community. It has substantial impact on the lives of victims, their children and other family members. It also places a significant demand on resources in the society. 2. The interdepartmental Clinical Practice Guide (CPG) sets out a multidisciplinary approach which enables clinicians (doctors and nurses) of a busy emergency department (ED) to provide holistic care for IPV patients, while taking up only a very minute proportion of their daily work. 3. IPV screening is very labour intensive in an ED with high patient census (attendance), and is of controversial value in the improvement of health outcome of victims.
    No preview · Article · Jan 2012
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    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.
    Full-text · Article · Jan 2012 · British Journal of Surgery
  • N.N. Sze · K.L. Tsui · S.C. Wong · F.L. So
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    ABSTRACT: Background: Cycling is not the primary mode of commuter transport in Hong Kong, yet cyclists are exposed to a high risk of injury and fatality in road crashes. It is essential to identify the significant factors contributing to severe injury among cyclists in Hong Kong. Aim: To evaluate the effects of significant factors, including demographics, temporal distribution, cyclist behavior, road conditions, and weather, on the risk of severe and life-threatening injury among cyclists in road crashes in Hong Kong. Method: The study was nested ona database known as Road Casualty Information System (RoCIS) which is a linked database between police traffic accident investigations reports and hospital injury records. A total of 682 victims were identified during the study period from 1 January 2004 to 31 December 2006. In particular, injured body part, demographics, helmet use, alcohol intoxication, weather conditions, road type and geometry, and collision characteristics of 682 trauma patients were the attributing variables of concern. The primary outcome measure was the injury severity of trauma patients which was classified into three levels: slight injury [Injury severity Scale (ISS) </=8], severe injury (ISS >/=9), and life-threatening injury (ISS >/=25). A multinomial logit regression model was established to evaluate the significance of factors contributing to severe and lifethreatening injuries among cyclists in road crashes. Results: The results indicated that middle-aged and elderly (35-54, RRR=2.48; and 55 or above, RRR=4.39) casualties and favourable weather conditions (2.56) significantly increased the risk of severe injury among cyclists. The presence of severe head injury(RRR=509.24), severe trunk injury (RRR=79.24), and the involvement of motor vehicles (RRR=27.18) substantially increased the risk of life-threatening injury to cyclists. Conclusions: Middle-aged casualties, the presence of head injuries, and the involvement of motor vehicles all increase the risk of more severe injury in bicycle-related crashes. Safety education and countermeasures should target at middle-aged and elderly cyclists and discourage cycling on the motorway.
    No preview · Article · May 2011 · Hong Kong Journal of Emergency Medicine
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    ABSTRACT: 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. 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. 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. 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.
    No preview · Article · Feb 2011 · The Journal of trauma
  • K.L. Tsui · N.N. Sze · F.L. So · S.C. Wong
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    ABSTRACT: Objective:To determine the association between alcohol impairment in drivers and risk of severe injury in other road users in Hong Kong. Method:The Road Casualty Injury Information System (RoCIS) was set up by linking a regional hospital injury registry to the police traffic injury database. Based on the year 2004 linked dataset, a specific model namely the External Casualty Model (ECM) was designed to measure the association between severe injury outcome of other (non-driver) road user casualties (as stratified by ISS groups [ISS <9 or ISS ≥9]) and the level of alcohol impairment (as measured by breath alcohol concentration [BAC <22 μg/100 ml or BAC ≥22 μg/100 ml]) in drivers involving in the crash, controlling for the driver's demographics (age and sex) and behaviour (as measured by driving-offence points [DOP]) and another attribute (day of week of crash). Binary logistic regression was used in the analysis. Results: Out of 1818 matched RoCIS cases in the year 2004, 439 ECM records were available for analysis. Alcohol impaired drivers led to a significantly higher risk of severe injury to other road users (OR=4.2, 95%CI=1.21, 14.36, p=0.02). Crashes on weekdays seemingly led to a lower severe injury risk (OR=0.57, p=0.08) than crashes on weekends. DOP of drivers did not predict a higher severe injury risk to other road users. Conclusions: Alcohol impairment on driver increases the risk of severe injury to other road users by four times. Road safety education campaign should stress on this adverse impact of drink driving on innocent people.
    No preview · Article · Jan 2010 · Hong Kong Journal of Emergency Medicine
  • K.L. Tsui · F.L. So · N.N. Sze · S.C. Wong · T.F. Leung
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    ABSTRACT: This study aims to evaluate the discordance between police reports of injury severity among road casualties and the length of hospital stay and the Injury Severity Scale (ISS) by linking information from the crash records of the Hong Kong Police with the trauma records of a regional hospital. Sensitivity and specificity analyses suggest that police injury grading diverges noticeably from the definition of a 12-h hospital stay. Police reports overestimate injury severity remarkably. The results of logistic regression indicate that age, the ISS, and the position of the victim significantly determine the likelihood of police injury misclassification. Furthermore, an optimal demarcation point of the length of hospital stay for serious injury is estimated.
    No preview · Article · Feb 2009 · Accident; analysis and prevention
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    CT Lui · KL Tsui · FL So · CL Lau · KL Ong · YH Tang

    Full-text · Article · Jan 2009 · Hong Kong Journal of Emergency Medicine
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    ABSTRACT: Trauma is the eighth leading cause of death in Hong Kong. In 2002, 18.5% of the population of Hong Kong was aged 55 years or above, which increased to 22.1% in 2006. The increasing older population in Hong Kong presents a challenge to the health care system yet there is little local data on older trauma patients. The objectives of this study are firstly to describe the epidemiology of high risk trauma in older patients in Hong Kong, and secondly to identify predictors of trauma mortality. Retrospective analysis of prospectively collected data from a centralised trauma database; data collected from 2002 to 2004 from four trauma centres in Hong Kong. Between 2002 and 2004, the four trauma centres had a total of 2,124,175 emergency department attendances of which 376,021 (17.7%) were trauma patients, and 80,827 (3.8%) were aged 55 years or older. 810 injured older patients met the inclusion criteria for this study. 380 (46.9%) patients had co-morbidity at the time of injury. Common causes of injury were falls (50.0%, 405/810) and motor vehicle crashes (33.6%, 272/810) of which (77.2%, 210/272) were pedestrians. Mortality was 24.4% (198/810) and increased with advancing age (p<0.0001). 53.5% (433/810) of patients had major trauma (ISS>15). Head injury contributed to 80.3% (159/198) of deaths. 38.4% (311/810) of patients required operations. Most patients were discharged home (40.5%, 328/810) and one-third (270/810) required rehabilitation. Significant predictors of mortality included co-morbidity, injury severity score, age and decreasing Glasgow Coma Score. Pedestrians struck by motor vehicles and falls are the principal causes of trauma in older patients in Hong Kong. Mortality increased with advancing age. The independent indicators of trauma mortality in older patients are co-morbidity, age, ISS and GCS.
    Preview · Article · Oct 2008 · Injury
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    K L Tsui · AY Chan · F L So · C W Kam
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    ABSTRACT: To examine risk factors for injury to married women from domestic violence in Hong Kong. Case control study. Regional public hospital, Hong Kong. All married women aged 18 to 60 years who attended an accident and emergency department for treatment of a domestic violence injury from January 2004 to June 2005. Social and health characteristics of abused women and their husbands. A total of 293 cases were compared to 313 controls. Eight predictive variables were found to be significant by univariate analysis: woman who is a new immigrant (P = 0.003), woman with no job (P = 0.019), husband with low educational level (P < 0.001), presence of extramarital affairs (P < 0.001), husband's unemployment (P < 0.001), husband's alcohol abuse (P < 0.001), husband's illicit drug abuse (P = 0.032), husband's mental illness (P < 0.001). Five factors were found to be significant in a logistic regression analysis: husband with a low educational level (nil to primary) [adjusted odds ratio = 2.78; 95% confidence interval, 1.149-6.727], husband unemployed (adjusted odds ratio = 9.031; 95% confidence interval, 5.163-15.796), presence of extramarital affairs (adjusted odds ratio = 5.218; 95% confidence interval, 2.899-9.395), husband's alcohol abuse (adjusted odds ratio = 6.089; 95% confidence interval, 3.460-10.716), husband's mental illness (adjusted odds ratio = 9.443; 95% confidence interval, 2.351-37.926). Several significant risk factors have been identified for injury incurred during domestic violence to married women in Hong Kong. It provides information useful for developing local preventive strategies.
    Preview · Article · Aug 2006 · Hong Kong medical journal = Xianggang yi xue za zhi / Hong Kong Academy of Medicine