Introduction Primary trauma diversion (PTD) enables direct transfer of major trauma patients to trauma centres for definitive care. This study aimed to evaluate the performance of PTD in the New Territories West Cluster (NTWC) of Hospital Authority and to identify the predictors for under-diversion. Methods A cross-sectional study based on local trauma registry. All major trauma patients (defined as ISS>15 or requiring trauma team activation) in the catchment area of the local hospital from September 2007 to December 2011 were included. The appropriateness of diversion decision was independently evaluated by an expert team (a trauma nurse coordinator and an emergency medicine practitioner). The sensitivity, specificity, predictive values, agreement, over-diversion and under-diversion rates were calculated. Potential predictors for under-diversion including age, Glasgow Coma Scale, mechanism of injury, injured body part, and the distance from scene to the trauma centre/local hospital were employed for logistic regression analysis. Results There were 141 eligible cases identified. The sensitivity and specificity for PTD were 59.5% and 96.5% respectively. The over-diversion rate was 3.5% and the under-diversion rate was 40.5%. The overall accuracy was around 74.5%. Non-motor vehicle accident (OR 13, 95% confidence interval [CI]=3.5-48.0, p<0.01) and isolated head injury (OR 5.35, 95% CI=1.5-19.5, p=0.01) were 2 independent predictors for under-diversion in PTD. Conclusions The overall field triage compliance by the paramedics is satisfactory. Under-diversion rate in NTWC is high. Non-motor vehicle accident mechanism and isolated head injury are 2 significant predictors for under-diversion. Reinforcement in training to avoid potential pitfalls would improve the paramedics' trauma triage performance.

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A dedicated program with guideline to enhance sepsis care was launched in July 2014 in Emergency Department (ED) of two regional hospitals. The study aimed to evaluate the effectiveness of the interventional program for severe sepsis patients, in antibiotic delivery rate and survival outcome. Methods: It is a beforeand-after interventional study with data from July to December 2013 and August 2014 to January 2015. A dedicated program for severe sepsis patients was introduced in July 2014. The outcome measures were blood culture rate, antibiotic administration rate in ED and mortality. Kaplan-Meier analysis and log-rank test was used for comparison of the survival. Multivariate Cox proportional hazards model was constructed to predict time to mortality adjusted for covariates. Results: 64 patients were included, 31 patients were in the pre-intervention group whereas 33 post-intervention. Both blood culture rate (29% vs 72.7%; p<0.001) and antibiotics administration in ED (38.7% vs 72.7%, p=0.0011) were significantly increased. Survival outcome was significantly improved in patients receiving timely antibiotics in ED (log-rank test p=0.016). Antibiotics administered in ED had hazard ratio of 0.178 (95% CI 0.053 to 0.595; p=0.005) in the Cox Proportional hazard regression model with adjustment of covariates. Age (adjusted odds ratio 1.06, 95% CI 1.01 to 1.12, p=0.033) and initial hypotension (adjusted odds ratio 0.97, 95% CI 0.95 to 0.99, p=0.005) were significant predictors of mortality. Conclusion: A dedicated guideline for severe sepsis management could improve blood culture rate, early antibiotics administration in the emergency department. Patients received early antibiotic had better outcome and survival.

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Background and Purpose: The concept of shoulder postural control or "scapular stabilization" has been commonly adopted as a therapeutic exercise in physiotherapy for the management of work-related neck and upper limb disorders (WRNULD). The objective of the present study is to investigate the muscle activities of the neck and upper limb muscles, while individuals perform functional tasks with and without scapular stabilization. Methods: Twenty healthy subjects aged between 20 and 40 will be recruited in this study. Surface electromyography (EMG) was recorded while the subjects performed a 5-min static typing task and a dynamic forward reaching task -with and without scapular stabilization. The muscles examined were the right upper and lower trapezii, anterior deltoid, biceps, triceps, flexor carpi radialis and extensor carpi radialis. EMG activities and amplitude ratios between agonistic and antagonistic muscles are compared with paired t-tests in different tasks. Results: In the pilot trials, upper trapezius demonstrated significantly lower activity (pZ0.045) with scapular stabilization compared to the condition without scapular stabilization. In contrast, lower trapezius showed higher activity (pZ0.026) with scapular stabilization. Anterior deltoid and forearm muscles did not show obvious changes with and without scapular stabilization. This pattern was consistent in both typing and dynamic movement tasks. Conclusion: The results have provided evidence to confirm the influence of scapular postural control on the muscle activity in the shoulder and upper limb muscles. This may provide better understanding to the physiotherapists when using scapular stabilization as a treatment for their patients with work-related neck and shoulder pain.