重大外傷病患闕漏損傷之發生率及影響因子

Incidence Rate and Influential Factors of Missed Injuries in Major Trauma Patients

陳昭文(Chao-Wen Chen)

指導教授 ： 林茂榮

臺北醫學大學/公共衛生暨營養學院/傷害防治學研究所/碩士(2009年)

https://doi.org/10.6831/TMU.2009.00018

摘要

目的：本研究為一回溯性世代研究，以某醫學中心之重大外傷病患為分析對象，探究其闕漏損傷(missed injury)之發生率與相關影響因子 方法：自民國九十五一月初至九十六年十二月底，976位於因重大外傷入住重症加護病房病患收案進入本研究。相關研究資料藉由病歷回溯分析取得。闕漏損傷於本研究中定義如下：任何傷患之外傷於急診處置時未發現，而於入住加護病房經再次檢視傷狀時發現者皆屬之。所發現之闕漏損傷依據簡易外傷分級(Abbreviated Injury Scale)歸類於二分以上者，另稱為臨床顯著性闕漏損傷。潛在影響闕漏損傷之因子被概分為三大類：傷患本身相關影響因子、環境相關影響因子與診治醫師相關影響因子。除了發生率資料之描述性呈現外，我們另利用Cox迴歸模型來校正分析因子間之相互干擾，以求取闕漏損傷之獨立影響因子。 結果：研究族群中總共有118人(12.1%)發生133項闕漏損傷事件。分佈於78位傷患中之87項闕漏損傷被歸類於臨床顯著性傷害。以重大外傷病患急診留置時間為計算基礎，所有闕漏損傷之發生率為每100人-時3.2次；而臨床顯著性闕漏損傷則為每100人-時2.1次。闕漏損傷依序最易發生於頭部、外觀軟組織與四肢部位。而Cox迴歸分析呈現出年齡較輕及傷害程度較嚴重者與闕漏損傷及臨床顯著性闕漏損傷之發生有顯著之關聯。此外，具有多重外傷與缺乏外觀軟組織傷害之患者較易產生闕漏損傷；而胸部或骨盆部位外傷之病患則較易發生臨床顯著性闕漏損傷事件。 結論：面對重大外傷病患，仍然有相當程度之傷害無法於急診處置時即完全察覺與確認。根據我們的研究，較年輕之族群、傷害嚴重度愈高之病患、多重外傷、合併胸部或骨盆外傷之患者皆與闕漏損傷或臨床顯著性闕漏損傷之發生相關。

關鍵字

延遲診斷 ； 急診 ； 傷害嚴重度危險因子 ； 外傷 ； 台灣

並列摘要

Objective: This retrospective cohort study was to determine the incidence and influential factors of missed injuries in major trauma patients in Taiwan.
Methods: Electronic hospital records on all 976 trauma patients admitted to intensive care units in a tertiary care hospital from January 2006 to December 2007 were reviewed. Missed injuries were defined as those unidentified in the emergency department but recognized later in intensive care units. Injuries with the Abbreviated Injury Scale of ≥ 2 were defined to be clinically significant. Cox regression analysis was applied to investigate factors associated with occurrence of missed injuries after adjustment for potential confounders.
Results: In the 2-year study period, there were 133 missed injuries in 118 patients, for a missed injury prevalence of 12.1%, with 87 of these missed injuries in 78 patients being clinically significant. The incidence rate of missed injuries and clinically significant missed injuries was 3.2 and 2.1 per 100 person-hours, respectively. The most commonly involved body region of missed injuries was the head, followed by soft tissues and extremities. The result of Cox regression analysis shows that younger ages and higher levels of Injury Severity Score were significantly associated with all missed injuries and clinically significant missed injuries. Additionally, polytrauma and absence of soft tissue injury were significantly associated with overall missed injuries, while patients with chest or pelvic injuries were more likely to have clinically significant missed injuries.
Conclusions: A considerable amount of injuries can be undetected in the emergency department. Younger ages, higher severity levels of injury, polytrauma, and presence of chest or pelvic injury are related to occurrence of missed injuries and clinically significant missed injuries.

並列關鍵字

Delayed diagnosis ； Emergency department ； Injury severity ； Risk factor ； Trauma ； Taiwan

參考文獻

Introduction……………………………………………….1

Material and methods………………………………..4

Study participants and settingting………………4

Data collection……………………………………………5

Results………………………………………………………..9