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This study aims to identify independent factors associated with cervical spinal injuries in head-injured patients. The extent of injuries to other body parts was assessed by the Abbreviated Injury Scale (AIS) and was included in the analysis. Consecutive head-injured patients admitted via the emergency department from January 1, 2014 to December 31, 2016 were retrospectively reviewed. The inclusion criteria were head-injured patients with an Abbreviated Injury Scale (AIS) score ≥2 (i.e., head injuries with intracranial hematoma or skull fracture). Patients with minor head injuries with only scalp abrasions or superficial lacerations without significant intracranial injuries (i.e., head injury AIS score = 1) were excluded. The primary outcome was to identify independent predictors associated with cervical spinal injuries in these head-injured patients. Univariate and multivariable analyses were conducted. A total of 1105 patients were identified. Of these patients, 11.2% (n = 124) had cervical spinal injuries. Univariate and multivariable analyses identified male gender (P = 0.006), the presence of thoracic injury (including rib fracture, hemothorax, or pneumothorax) (P = 0.010), and hypotension with systolic blood pressure <90 mm Hg on admission (P = 0.009) as independent predictors for cervical spinal injury in head-injured patients. This study showed that about 1 in 10 patients with significant head injury had cervical spine injury, usually associated with fracture or dislocation. Male gender, the presence of thoracic injury, and hypotension on admission were independent risk factors associated with cervical spinal injuries. [ABSTRACT FROM AUTHOR]

Purpose: The mortality rate in patients with haemodynamically unstable pelvic fractures is as high as 40-60%. Despite the new advances in trauma care which are in phase in trauma centres in Hong Kong, the management of haemodynamically unstable pelvic fracture is still heterogeneous. The aim of this study is to review the results of management of haemodynamically unstable pelvic fracture patients in Hong Kong over a five year period.Methods: This is a retrospective multi-centred cohort study of patients with haemodynamic and mechanically unstable pelvic fractures from 1 January 2010 to 31 December 2014. The primary outcome investigated is mortality of patients (including overall, 30-day, 7-day and 24-hour mortalities).Results: Implementation of three-in-one pelvic damage control protocol was identified to be a significant independent predictive factor for overall, 30-day, seven-day and 24-hour mortalities. The overall in-hospital and 30-day mortality rates for patients managed with three-in-one protocol was 12.5%, while it was 11% for seven day mortality and 6% for 24 hour mortality. There were no significant differences in demographic characteristics, physiological measurements, types of pelvic fracture, severity and mechanism of injury between patients managed with or without three-in-one protocol.Conclusions: Implementation of the multidisciplinary three-in-one pelvic damage control protocol reduces mortality and therefore should be highly recommended. The results are convincing as it has eliminated the limitations of our previous single-centred trial. [ABSTRACT FROM AUTHOR]

Aim To achieve better outcomes, nonoperative management (NOM) and damage control surgery (DCS) are now recommended for traumatic liver injury. The aim of the present study was to review the outcomes of patients suffering from liver trauma and to determine the factors affecting the outcomes, with emphasis on NOM and DCS. Patients and Methods This was a retrospective cohort study for liver trauma patients from a single centre. The outcomes were compared between two equal consecutive periods: period A (2001-2007) and period B (2008-2014). Results There were 116 patients, with a mean age of 38.1 years and a male predominance (61.2 per cent). Approximately 57 per cent of patients suffered from grade III or higher liver injury. The mean Injury Severity Score (ISS) was 32.3. The 90-day mortality was 20.7 per cent. During period B, the 90-day mortality was significantly lowered (6/56 vs 18/60, P = 0.010) with less liver operations (13/56 vs 26/60, P = 0.022) and more hepatic angiography ± embolization (7/56 vs 0/60, P = 0.005). The proportion of DCS was similar, but more hepatectomies were performed in period B (4/13 vs 0/26, P = 0.009). Multivariate analysis revealed that ISS grade, age and sex were predictors for 90-day mortality. Conclusions Reduced mortality was seen in traumatic liver injury accomplished by increased NOM, but not DCS. [ABSTRACT FROM AUTHOR]

Abstract: Background: There is limited evidence to guide the recognition of patients with massive, uncontrolled hemorrhage who require initiation of a massive transfusion (MT) protocol. Objective: To risk stratify patients with major trauma and to predict need for MT. Designs: Retrospective analysis of an administrative trauma database of major trauma patients. A regional trauma Centre: A regional trauma centres in Hong Kong. Patients: Patients with Injury Severity Score ≥9 and age ≥12 years were included. Burn patients, patients with known severe anemia and renal failure, or died within 24h were excluded. Main outcome measures: Delivery of ≥10 units of packed red blood cells (RBC) within 24h. Results: Between 01/01/2001 and 30/06/2009, 1891 patients met the inclusion criteria. 92 patients required ≥10 units RBC within 24h. Seven variables which were easy to be measured in the ED and significantly predicted the need for MT are heart rate ≥120/min; systolic blood pressure ≤90mmHg; Glasgow coma scale ≤8; displaced pelvic fracture; CT scan or FAST positive for fluid; base deficit >5mmol/L; hemoglobin ≤7g/dL; and hemoglobin 7.1–10g/dL. At a cut off of ≥6, the overall correct classification for predicting need for MT was 96.9%, with a sensitivity of 31.5% and specificity of 99.7%, and an incidence of MT of 82.9%. The area under the curve was 0.889. Conclusion: A prediction rule for determining an increased likelihood for the need for massive transfusion has been derived. This needs validation in an independent data set. [Copyright &y& Elsevier]