Comparison of the effectiveness of trauma services provided by secondary and tertiary hospitals in Malaysia

Dinesh Sethi, Syed Mohamed Al-Junid Syed Junid, Saperi Sulong, Felicity Clemens, Pollyanna Hardy, Diana Elbourne, Anthony B. Zwi

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Study objective: The trauma services provided by 6 hospitals operating at 2 levels of care (4 secondary or district general hospitals and 2 tertiary care hospitals) in Malaysia are compared in terms of mortality and disability for direct admissions to emergency departments to test the hypothesis that care at a tertiary care hospital is better than at a district general hospital. Methods: All cases were recruited prospectively for 1 year. The hospitals were purposefully selected as typical for Malaysia. There are 3 primary outcome measures: death, musculoskeletal impairment, and disability at discharge. Adjustment was made for potential covariates and within-hospital clustering by using multivariable random-effects logistic regression analysis. Results: For direct admissions, logistic-regression-identified odds of dying were associated with older age (>55 years), odds ratio (OR) 1.9 (95% confidence interval [CI] 1.3 to 2.8); head injury, OR 2.7 (95% CI 1.9 to 3.9); arrival by means other than ambulance, OR 0.6 (95% CI 0.4 to 0.8); severe injuries (Injury Severity Score >15) at a district general hospital, OR 45.2 (95% CI 27.0 to 75.7); severe injuries at a tertiary care hospital, OR 11.2 (95% CI 7.3 to 17.3); and admission to a tertiary care hospital compared to a district general hospital if severely injured (Injury Severity Score >15), OR 0.2 (95% CI 0.1 to 0.4). Admission to a tertiary care hospital was associated with increased odds of disability (OR 1.9; 95% CI 1.5 to 2.3) and musculoskeletal impairment (OR 3.5; 95% CI 2.7 to 4.4) at discharge. Conclusion: Care at a tertiary care hospital was associated with reduced mortality (by 83% in severe injuries), but with a higher likelihood of disability and impairment, which has implications for improving access to trauma services for the severely injured in Malaysia and other low- and middle-income settings.

Original languageEnglish
JournalAnnals of Emergency Medicine
Volume49
Issue number1
DOIs
Publication statusPublished - Jan 2007

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Malaysia
Tertiary Care Centers
Tertiary Healthcare
Odds Ratio
Confidence Intervals
District Hospitals
Wounds and Injuries
General Hospitals
Injury Severity Score
Logistic Models
Secondary Care
Ambulances
Mortality
Craniocerebral Trauma
Cluster Analysis
Hospital Emergency Service
Regression Analysis
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Emergency Medicine

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Comparison of the effectiveness of trauma services provided by secondary and tertiary hospitals in Malaysia. / Sethi, Dinesh; Syed Junid, Syed Mohamed Al-Junid; Sulong, Saperi; Clemens, Felicity; Hardy, Pollyanna; Elbourne, Diana; Zwi, Anthony B.

In: Annals of Emergency Medicine, Vol. 49, No. 1, 01.2007.

Research output: Contribution to journalArticle

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abstract = "Study objective: The trauma services provided by 6 hospitals operating at 2 levels of care (4 secondary or district general hospitals and 2 tertiary care hospitals) in Malaysia are compared in terms of mortality and disability for direct admissions to emergency departments to test the hypothesis that care at a tertiary care hospital is better than at a district general hospital. Methods: All cases were recruited prospectively for 1 year. The hospitals were purposefully selected as typical for Malaysia. There are 3 primary outcome measures: death, musculoskeletal impairment, and disability at discharge. Adjustment was made for potential covariates and within-hospital clustering by using multivariable random-effects logistic regression analysis. Results: For direct admissions, logistic-regression-identified odds of dying were associated with older age (>55 years), odds ratio (OR) 1.9 (95{\%} confidence interval [CI] 1.3 to 2.8); head injury, OR 2.7 (95{\%} CI 1.9 to 3.9); arrival by means other than ambulance, OR 0.6 (95{\%} CI 0.4 to 0.8); severe injuries (Injury Severity Score >15) at a district general hospital, OR 45.2 (95{\%} CI 27.0 to 75.7); severe injuries at a tertiary care hospital, OR 11.2 (95{\%} CI 7.3 to 17.3); and admission to a tertiary care hospital compared to a district general hospital if severely injured (Injury Severity Score >15), OR 0.2 (95{\%} CI 0.1 to 0.4). Admission to a tertiary care hospital was associated with increased odds of disability (OR 1.9; 95{\%} CI 1.5 to 2.3) and musculoskeletal impairment (OR 3.5; 95{\%} CI 2.7 to 4.4) at discharge. Conclusion: Care at a tertiary care hospital was associated with reduced mortality (by 83{\%} in severe injuries), but with a higher likelihood of disability and impairment, which has implications for improving access to trauma services for the severely injured in Malaysia and other low- and middle-income settings.",
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