1.Comparison of trauma systems in Asian countries: a cross-sectional study
Young Hee JUNG ; Dae Han WI ; Sang Do SHIN ; Hideharu TANAKA ; Goh E SHAUN ; Wen Chu CHIANG ; Jen Tang SUN ; Li Min HSU ; Kentaro KAJINO ; Sabariah Faizah JAMALUDDIN ; Akio KIMURA ; James F HOLMES ; Kyoung Jun SONG ; Young Sun RO ; Ki Jeong HONG ; Sung Woo MOON ; Ju Ok PARK ; Min Jung KIM
Clinical and Experimental Emergency Medicine 2019;6(4):321-329
OBJECTIVE: This study aimed to compare the demographic characteristics and trauma service structures and processes of hospitals in 15 countries across the Asia Pacific, and to provide baseline data for the integrated trauma database: the Pan-Asian Trauma Outcomes Study (PATOS).METHODS: Medical directors and emergency physicians at PATOS-participating hospitals in countries across the Asia Pacific were surveyed through a standardized questionnaire. General information, trauma care system data, and trauma emergency department (ED) outcomes at each hospital were collected by email and analyzed using descriptive statistics.RESULTS: Survey data from 35 hospitals across 15 countries were collected from archived data between June 2014 and July 2015. Designated trauma centers were identified as the highest hospital level for trauma patients in 70% of surveyed countries. Half of the hospitals surveyed had special teams for trauma care, and almost all prepared activation protocol documents for these teams. Most hospitals offered specialized trauma education programs, and 72.7% of hospitals had a hospital-based trauma registry. The total number of trauma patients visiting the ED across 25 of the hospitals was 300,376. The overall survival-to-discharge rate was 97.2%; however, it varied greatly between 85.1% and 99.7%. The difference between survival-to-discharge rates of moderate and severe injury groups was highest in Taiwan (41.8%) and lowest in Thailand (18.6%).CONCLUSION: Trauma care systems and ED outcomes vary widely among surveyed hospitals and countries. This information is useful to build further detailed, systematic platforms for trauma surveillance and evidence-based trauma care policies.
Asia
;
Asian Continental Ancestry Group
;
Cross-Sectional Studies
;
Education
;
Electronic Mail
;
Emergencies
;
Emergency Service, Hospital
;
Epidemiology
;
Humans
;
Physician Executives
;
Taiwan
;
Thailand
;
Trauma Centers
2.Administration of tranexamic acid for victims of severe trauma within pre-hospital care ambulance services (PHCAS) in Malaysia
Shah Jahan Mohd Yussof ; Shamila Mohamad Ali ; Nurul Azlean Norzan ; Mohd Amin Mohidin ; Anandakumar Krishnan ; Ahmad Ibrahim Kamal Batcha ; Ahmad Tajuddin Mohamad Nor ; Aik Howe Teo ; Mohamed Saed Mian ; Fatahul Laham Mohamed ; Ridzuan Mohd Isa ; Mohd Idzwan Zakaria ; Mohd Khairizam Mohd Yusoff ; Joseph Mathew ; Mark Fitzgerald ; Sabariah Faizah Jamaluddin ; Kiat Kee Gan
The Medical Journal of Malaysia 2019;74(4):300-306
Introduction: Trauma is a Global threat and the 5th highest
cause of all-cause mortality in Malaysia caused
predominantly due to road traffic accidents. Majority of
trauma victims are young adults aged between 21-40 years
old. In Malaysia, 24 out of 100,000 population die annually
due to trauma, rating us amongst the highest in South East
Asia. These alarming figures justify aggressive preventive
and mitigation strategies. The aim of this paper is to
promote the implementation of evidence-based
interventions that will reduce the rate of preventable death
because of trauma. Tranexamic acid is one of the few
interventions in the early management of severe trauma with
level-one evidence. Tranexamic acid has been proven to
reduce all causes of mortality and mortality due to bleeding.
Evidence proves that it is most effective when administered
early, particularly within the 1st hour of trauma. This
proposed guideline is formulated based upon quality
evidence from multicentre studies, clinical practices in other
countries and consideration of the local demographic
factors with the intent of enabling an easy and simple
pathway to administer tranexamic acid early in the care of
the severely injured.
Conclusion: The guideline highlights select pre-hospital
criteria’s and the methods for drug administration. The
authors recognise that some variants may be present
amongst certain institutions necessitating minor
adaptations, nevertheless the core principles of advocating
tranexamic acid early in the course of pre-hospital trauma
should be adhered to.