老年重大外傷和住院天數相關性之探討

Correlation between Geriatric Major Trauma Patients and Length of Hospital Stay

顏淑婷(Shu-Ting Yen) ； 戴碩瑩(Shuo-Ying Dai) ； 楊宗翰(Tsung-Han Yang) ； 王志榮(Chih-Jung Wang) ； 顏亦廷(Yi-Ting Yen) ； 應純哲(Jeremy C. Ying)

《台灣老年醫學暨老年學會雜誌》 14卷4期 (2019/11) Pp. 218-228

https://doi.org/10.29461/TGGa.201911_14(4).0003

摘要

目的：老年人口常伴隨其他慢性疾病，若因外傷就醫往往會增加照護上的困難。本研究目的為了解老年重大外傷病人住院天數在個案醫院外傷科成立後其照護品質是否持續改善。方法：本研究以病歷回溯方式，利用台南市某醫學中心外傷資料庫，選取2011～2015年65歲以上重大外傷（Injury Severity Score, ISS≥16）因外傷從急診入住外傷科病人共108人，分為對照組：外傷科成立前期（2011～2013年，50人）及個案組：外傷科成立近期（2014～2015年，58人），利用SPSS 18.0統計軟體，以卡方、相關、獨立樣本t檢定及迴歸等方法探討老年重大外傷族群其加護病房（Intensive Care Unit, ICU）天數及住院天數在外傷科成立前期及近期進行照護品質差異性分析。結果：僅ISS=16～24的老年重大外傷族群其ICU天數在成立近期較前期短（5 vs. 13）；外傷科成立近期的老年重大外傷病人僅ISS會影響ICU天數及住院天數，且ISS每增加1分會增加0.568天的ICU天數，增加0.819天的住院天數。討論：外傷科成立前期及近期，ICU天數及住院天數沒有差異。外傷科成立近期ISS可以做為評估老年重大外傷族群ICU天數及住院天數的因子。本結果可以提供給各急救責任醫院對於持續性照護品質及衛生主管機關對於老年重大外傷之住院天數管理做為參考。

關鍵字

老年 ； 重大外傷 ； 外傷科 ； 住院天數

並列摘要

Objectives: Chronic diseases are common among the geriatric population, and trauma could complicate the medical care for them. The purpose of this study was to explore the quality of care in terms of Intensive Care Unit (ICU) stay and length of stay for geriatric major trauma patients admitted to the trauma center of the case hospital. Methods: Medical history charts obtained from the hospital's trauma database was reviewed. 58 patients aged over 65 and admitted through the emergency department for major trauma (Injury Severity Score, ISS≥16) during 2014~2015 were selected as the case group. In addition, 50 patients admitted through the emergency department during 2011~2013 were selected based on the same inclusion criteria as the comparison group. Statistical software SPSS 18.0 was used to perform Chi-square, Pearson correlation and independent t-test, regression analyses for examining the differences in ICU stay and length of stay between the case and comparison groups. Results: Among severe trauma patients (ISS=16~24), ICU stay of the case group was significantly shorter than that of comparison group (5 vs. 13 days). ISS was the significant predictor of ICU stay and LOS among the case group. A one-point rise in the ISS score led to an extension of 0.568 days for ICU stay and 0.819 days for LOS. Conclusion: No overall significant differences between the case and comparison groups were found. However, ISS was identified as a significant predictor of ICU stay and length of stay for the case group. The study results can be used as references for assessing continuous quality care for hospital trauma center and for drafting policy related to trauma patients' length of stay standard for the National Healthcare Insurance Administration.

並列關鍵字

geriatric ； major trauma ； trauma team ； length of stay