嚴重外傷存活病患的失能影響因素

Factors Associated with Disability after Major Trauma

李卓倫(Jwo-Leun Lee) ； 陳瑞杰(Ray Jade Chen) ； 陳文意(Wen-Yi Chen) ； 梁亞文(Yia-Wun Liang) ； 陳慈純(Tzu-Chun Chen)

《台灣公共衛生雜誌》 29卷6期 (2010/12) Pp. 518-527

https://doi.org/10.6288/TJPH2010-29-06-06

摘要

目標：外傷照護的終極目標是讓病患恢復到受傷之前的功能，本研究藉由嚴重外傷病患的失能結果與相關因素的分析，提供部分臨床治療準則與制訂政策的參考依據。方法：分析2005年7月l日至2008年6月30日中部某醫學中心嚴重外傷存活病患(ISS≧16)1，036人，其中失能病患318人，以多變項邏輯斯迴歸分析失能的因素，包括性別、年齡、到院方式、到院時昏迷指數、血壓、每分鐘呼吸次數、以及受傷機轉、傷害嚴重度、是否有過去病史、治療過程是否有手術、是否有併發症。結果：年齡每增加1歲，失能勝算增加11%，失能機率增加0.002；女性與男性病患的失能勝算比153（信賴區間1.11-2.12)，女性失能機率比男性高出0085；到院時昏迷指數(GCS)小於13分的失能勝算比237（信賴區間1.68-3.35），失能機率增加0.178；治療過程曾手術的病患失能勝算比3.97（信賴區間2.80-5.61），失能機率增加0.260；有併發症者的失能勝算比2.86（信賴區間1.97-4.15），失能機率增加0.227。結論：初期治療決策的適當性與臨床醫療的照護品質顯著影響嚴重外傷病患的治療結果，適當的醫療決策包括依據生命徵象與昏迷指數，做為院前緊急救護和到院後檢傷分類的標準，並且以受傷部位和嚴重度，來決定是否啓動跨科別的外傷小組，進入重大外傷處置流程；臨床照護品質主要則為降低併發症的發生。

關鍵字

外傷 ； 照護品質 ； 失能 ； 危險因子 ； 外傷登錄

並列摘要

Objectives: The ultimate goal of trauma care is to restore patients to the level of health they enjoyed before injury. This study analyzed the risk factors for physical dysfunction after trauma care. Methods: A Trauma Registry dataset for July 2005 to June 2008, based at a medical center in central Taiwan, was used to analyze the factors related to disability after major trauma by the use of logistic regression models. Results: The probability of disability was increased by several factors: each additional year of age by 0.002 (OR=1.01; CI:1.00-1.02), being female by 0.085 (OR=1.53; CI:1.11-2.12), having a Glasgow Coma Score less than 13 by 0.178 (OR=2.37; CI:1.68-3.35), and an operation or complications during trauma care by 0.260 (OR=3.97; CI:2.80-5.61) and 0.227 (OR=2.86; CI:1.97-4.15), respectively. Conclusions: Evidence from this study supports making appropriate decisions during the initial phase of care. An appropriate decision to activate the cross-specialty trauma team according to risk factors and reducing complications are the most important guidelines for the optimal care of major trauma patients. When properly applied, the trauma registry system is helpful for quality control and the development of quality improvement programs in hospitals.

並列關鍵字

Trauma ； Medical care quality ； Disability ； Risk factor ； Trauma registry

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