China Trauma Collaboration

Background & Aims

The burden of disease associated with survivors of trauma is substantial. With the Chinese Ministry of Health estimating that 750 000 citizens are killed and approximately 3.5 million hospitalized per annum as a consequence of trauma related injuries, the mortality and morbidity associated with injuries in China represents a significant public health concern. The associated productivity losses are immense, equating to an estimated US$12.5 billion, or 12.6 million potentially productive life years lost (PPYL). Motor vehicle crashes alone represent one-quarter of the total injury PPYL. With the rapid increase in motorization, combined with growth across many industry sectors, the burden of injury in China is likely to grow, placing considerable demand on pre-hospital, hospital and rehabilitation services.

It is within this context that we aim to develop a long-term collaborative research and education program focussed on pre-hospital and in-patient trauma care. This collaborative research program involves a number of hospital emergency departments in Beijing, Shanghai and Chengdu, and is being coordinated by The George Institute, China.

The research program consists of a number of distinct phases, commencing with a review of the local medical literature with the goal of documenting the characteristics and outcomes of patients, patient volume, as well as system structures. We aim to improve public health by developing long term clinical research, public health and education programs. A key objective therefore is to develop an on-going registry based study that will serve as a platform for identifying and addressing future challenges in trauma care in China.

Research Goals

This research program aims to achieve a number of goals, these being:

• To identify patterns and volumes of trauma presenting to major metropolitan and regional centres.
• To identify the volume of patients presenting to hospitals and to determine associated outcomes. This may also address the question of whether differences in patient volume between centres are associated with patient mortality.
• To define the status of trauma registry and database capability within major Chinese metropolitan and regional hospitals.
• To define the awareness and adoption of trauma resuscitation protocols in metropolitan, regional and rural hospitals.
• To define the necessity and capacity for the retrieval of trauma patients from regional and rural centres to metropolitan hospitals.
• To determine factors associated with patient mortality and morbidity, with a view to implementing and evaluating initiatives designed to improve public health.

Program Design

The research program can be broadly divided into five Phases, with each subsequent Phase building on the preceding Phases. The Phases of the research program are:

• A review of emergency medicine and trauma literature published in China
• Survey-based study of hospital systems, structures and patient volume
• Prospective cohort study of presentations and admissions to hospital
• Establishment of an enhanced trauma registry surveillance system
• Intervention studies (educational initiatives and public health programs)

Current Status

The opening meeting was conducted at The George Institute in Beijing on 20 November 2007. This meeting established the study team and set the basis for the future success of the program.

The findings from Phase 2 of the study will be presented in Beijing in May 2008. This survey was completed by study collaborators and provides information concerning hospital systems, structures and patient capacity. A proposal for Phase 3 will be discussed at this meeting.

Publications and Presentations

Myburgh, J. A study of the trauma system and development of a model hospital research program in China. 10th Annual Meeting of the Australian and New Zealand Intensive Care Society and Clinical Trials Group, Noosa, Australia, March 2008.

Institute Investigators

• The George Institute for International Health (Sydney)
  • Professor John Myburgh
  • Professor Simon Finfer
  • Dr Michael Fitzharris
• The George Institute, China (Beijing)
  • Professor Wu Yangfeng
  • Dr James Yu
  • Ms Naomi Hammond

Collaborators

• Beijing
  • Professor Yu Xuezhong, Director, Emergency department, Peking Union Medical College Hospital
  • Professor Wang Zhong, Vice-Chair, Emergency Department, Peking Union Medical College Hospital
  • Professor Du Bin, Director of ICU, Peking Union Medical College Hospital
  • Professor Zhang BaoZhong, Orthopedics Department, Peking Union Medical College Hospital
  • Professor Zhao Bin, Director, Emergency department, JiShuiTan Hospital
  • Professor Yu DongMing, Director, Emergency department, TianTan Hospital
  • Professor He ZhongJie, Director, ICU, Emergency Department, PLA 304 Hospital
  • Professor Zheng YaAn, Emergency department, the 3rd affiliated Hospital of Peking University
  • Professor Zhu JiHong, Director, Emergency department, Peking Univerity People's Hospital
  • o Professor An YouZhong, Director, ICU, Peking Univerity People's Hospital
• Chengdu
  • Professor He Qing, Director, Emergency Department, SiChuang University HuaXi Hospital
• Shanhai
  • Professor Lu YiMing, Director, Emergency Department, RuiJing Hospital

Funders

• The George Institute for International Health

中国创伤协作组

背景和目的

由创伤造成疾病负担巨大，中国卫生部估计每年因伤害有75万人死亡，约350万人住院，伤害所导致的死伤已成为重要的公共卫生问题。与此相关的生产力损失也是巨大的，相当于125亿美元或1200万潜在生产寿命年（PPYL）损失。仅道路交通事故就占四分之一的PPYL损失。随着快速机动化进程和工业发展，中国伤害负担有可能进一步增加，这也对院前救护、院内和康复服务提出了更高要求。

在这样背景下，我们旨在开展一项长期的关注于院前和院内创伤救治的协作研究教育项目。这个协作研究项目有北京、上海和成都的一些医院急诊科室参与，由中国乔治中心牵头（协调）。

这个研究项目分为几个阶段，首先是对本地医学文献进行回顾，以了解患者特征和结局、患者流量以及医疗系统结构。我们旨在开展长期的临床研究、公共卫生和教育项目，以促进公共卫生。因此一个主要目标是开展一项基于病例登记系统的研究，作为一个平台以了解和阐明创伤救治领域未来的挑战。

研究目的

这个研究项目要达到以下几个目的：

1. 确定主要的大城市医院和地区医院创伤患者类型和流量。
2. 了解到医院就诊的患者流量和患者结局。这也可以帮助回答是否患者流量与结局之间有联系。
3. 了解在主要的都市医院和地区医院内，创伤病例登记系统现状和建立数据库能力
4. 了解在都市、地区和农村医院，对创伤复苏规范了解程度和使用情况。
5. 了解将创伤患者从地区和农村医院转诊到都市医院的必要性和能力。
6. 判断与患者死亡率和发病率有关因素，为开展和评价促进公共卫生的干预活动提供依据。

项目设计

研究项目可以大致分为五个阶段，每个之面的阶段为后面阶段的基础，分别是：

1. 对中国发表的急救和创伤文献进行回顾
2. 对医院系统、结构和患者流量的调查
3. 对医院就诊患者的前瞻性队列研究
4. 建立一个改进的创伤病例登记监测系统
5. 干预研究（教育和公共卫生项目）

目前进展

2007年11月20日在北京乔治中心召开了启动会议。在此次会议上建立研究团队，为以后项目开展奠定基础。

在2008年5月份在北京还将召开会议，以会上将讨论第II阶段调查的结果。这次调查由研究协作者完成，提供了医院系统、结构和患者接待能力的有关信息。在这次会议上将讨论第3阶段的方案。

出版物和会议报告

Myburgh, J. A study of the trauma system and development of a model hospital research program in China. 10^th Annual Meeting of the Australian and New Zealand Intensive Care Society and Clinical Trials Group, Noosa, Australia, March 2008.

乔治中心研究人员

乔治国际卫生研究中心（愁尼）

• Professor John Myburgh 教授
• Professor Simon Finfer 教授
• Dr Michael Fitzharris 博士

The George Institute, China (Beijing) 中国乔治中心（北京）

• Professor Wu Yangfeng 武阳丰教授
• Dr James Yu 俞学群博士
• Naomi Hammond 女士

协作者

Beijing 北京

• 北京协和医院，急诊科主任，于学忠教授
• 北京协和医院，急诊科副主任，王仲教授
• 北京协和医院，ICU主任，杜斌教授
• 北京协和医院，骨科，张保中教授
• 北京积水潭医院，急诊科主任，赵斌教授
• 北京天坛医院，急诊科主任，于东明教授
• 解放军304医院，ICU主任，何忠杰教授
• 北京大学附属第医院，急诊科，郑亚安教授
• 北京大学人民医院，急诊科，朱继红教授
• 北京大学人民医院，ICU主任，安有仲教授

成都

• 四川大学华西医院，急诊科主任，何庆教授

上海

• 瑞金医院，急诊科主任，陆一鸣教授

资助者

• The George Institute for International Health 乔治国际卫生研究中心