Most Proposed Topic :
Enhancing Partnership with Patients and Community (projects initiated to engage patient and improve patient communication)
Proposed Topic (Second preferred): :
HA Young Investigators Session (Projects to be presented by HA staff who had joined HA for less than 15 years)
Authors: (including presenting author): :
Zhu JY(1), Li YH(1)(2), Cheung NK(1)(2), Cheng CH(1)(2), Cheung KH(1)(2), Man SY(1)(2), Graham CA(1)(2) Hung KCK(2)
Affiliation: :
(1)Trauma and Emergency Centre, Prince of Wales Hospital, (2)Accident and Emergency Medicine Academic Unit, The ChineseUniversity of Hong Kong
Introduction: :
Mild complicated traumatic brain injury (cmTBI) is a common presentation encountered in the Emergency department. About 2.8 million people sustain a traumatic brain injury (TBI) annually and about two-thirds of the injuries are classified as mild. The current management in Hong Kong for TBI includes neurosurgery consultation, hospital admission and monitoring, repeat CT brain in the next 6 hours, especially when the injury is complicated with intracranial hemorrhage (ICH). The Brain Injury Guidelines (BIG) introduced an algorithm and provided an option for patients with mild TBI, even in some TBI cases with ICH to be treated differently from traditional management. The modified Brain Injury Guidelines (mBIG) further refined the original algorithm and improved in safety and reproducibility. There have already been several studies demonstrating the safety and effectiveness in saving medical resources withmBIG algorithm implementation towards patients with TBI. However, there is yet no local data in Hong Kong to validate whether it is a safe and effective tool to apply as well in the Hong Kong population.
Objectives: :
This study aims to determine the application of mBIG algorithms at one hospital site during the 2021-2022. With the mBIG algorithm retrospectively implemented onto the qualified patients retrieved from the trauma registry and CDARS of PWH, we will validate the safety and efficiency of this algorithm. By comparing the expected outcome with retrospectively implemented mBIG protocol, against the actual outcomes on discharge, we hope to enable evidence-based models in the future for a safe and more efficient treatment of minor TBI with reasonably less allocations of medical resources.
Methodology: :
This will be a retrospective cohort study. We plan to examine the trauma registry and CDARS of PWH for patients presenting with mBIG 1 and mBIG 2 TBI for the above-mentioned 2- year duration. We plan to quantitatively assess these cases over the outcomes before and after implementation of mBIG algorism and then compare them statistically.
Statistical analysis
General
Chi-square and Fisher’s exact tests will be used for categorical data while t-tests will be used to compare means of continuous variables. A p-value < 0.05 will be considered statistically significant.
Software
We will be performing suitable analyses using the statistical package IBM SPSS Statistics software (SPSS)
Analysis
A univariate and multivariate analysis of the data set will be conducted for the collected data.
Multivariate logistic regression analysis
Parameters with a p-value < 0.20 will be entered into a multiple logistic regression model and used to evaluate associations and account for variation. Multiple logistic regression adjusts for variable interactions and will be used to identify those factors most associated with event rate if any.
Result & Outcome: :
Outcomes
The outcome measure will be the following factors collected from head injury patients seen at PWH.
1. One-day discharge rate
2. ED length of stay (LOS)
3. Neurosurgical intervention
4. Hospital LOS
5. 7- day return visit
the other outcome measured would include exploring the effect of age, comorbidities in length of stay as to suggest modification on local utilization.
