交通事故創傷病患之嚴重度影響因素、創傷整體表現以及醫療照護之相關研究－以中部地區為例

Factors Associated with Injury Severity, Overall Triage Performance, and Medical Care among Victims of Motor Vehicle Crashes in Central Taiwan

李政宜(Cheng-Yi Li)

指導教授 ： 馬惠明

國立臺灣大學/公共衛生學院/預防醫學研究所/碩士(2008年)

https://doi.org/10.6342/NTU.2008.00923

摘要

交通事故傷害往往對國家社會、經濟和醫療造成重大的負擔，其死亡率位居全球死亡率第九名，造成全球的經濟負擔約為五億一千八百萬美金。近年來，台灣意外事故死亡率居十大死亡中的第五名，其中交通事故的比例最高，約佔了一半，可見交通事故的影響之大。
本研究連結警政署交通事故資料庫、健保資料庫及死因資料庫，分析民國92年台灣中部地區的交通事故，探討1)交通事故嚴重度的影響因素；2)不同嚴重度創傷病患的整體創傷表現；3)創傷病患在不同醫療層級院所接受治療，其住院天數以及30天死亡率的差異;4)交通事故在城鄉之間，現場死亡、整體檢傷表現、住院天數和30天死亡率的差異。
研究結果顯示，影響事故嚴重度的因素中，關於人的因素部份，影響因素包括：年齡（30-65歲；大於65歲）、無照駕駛、酒後駕車；車輛因素部份包括：騎乘機車、未使用安全帶或安全帽、車輛撞擊路邊固定物；地理及環境因素部份包括：夜間行車、行駛於速限較高的道路（50-80km/h；大於80km/h）、發生於彰化縣、非十字路口以及號誌功能不良處的事故。
中部地區檢傷整體表現，以醫學中心和非醫學中心為分類標準，敏感度為30.61％，特異度為77.04％。檢傷過度在各縣市之間的比較為：台中市＞彰化縣＞南投縣＞台中縣；檢傷不足在各縣市之間的比較為：台中縣＞南投縣＞彰化縣、台中市。以區域及以上醫院和地區醫院為分類標準，敏感度為83.45％，特異度為28.52％。檢傷過度在各縣市之間的比較為：台中市＞台中縣＞彰化縣＞南投縣；檢傷不足在各縣市之間的比較為：南投縣＞台中縣＞彰化縣＞台中市。
醫院層級在醫療照護的比較中顯示，住院天數為醫學中心住院天數高於區域醫院，區域醫院高於地區醫院。其他影響住院天數的因素包括：是否死亡、嚴重度、性別、年齡、駕照有無、事故發生縣市、事故車輛、事故發生時間、道路速限及是否跨縣市住院等。30天死亡率為醫學中心和區域醫院無顯著差異，但地區醫院30天死亡率低於醫學中心及區域醫院。其他影響30天死亡率的因素包括事故發生地點、性別及是否酒駕。
城鄉差距的比較，在事故現場死亡部份，鄉村現場死亡比例高於城市。整體檢傷表現中，無論以醫學中心或是區域級以上醫院為分類標準，敏感度表現為城市＞鄉村，特異度表現為鄉村＞城市。住院天數比較在城鄉之間無顯著差異，而30天死亡率則是鄉村高於城市。
預防勝於治療，若能減少本研究結果中造成嚴重事故的因素，相信能減少嚴重交通事故的發生，也能夠降低生命財產的損失。中部地區的檢傷表現並不理想，各縣市之間的檢傷表現差異性也大，此有賴進一步改善醫療制度，包括院前救護，以及創傷醫療制度。本研究對於創傷病患的醫療照護表現分析結果，與國外研究結果有所不同，可能和本研究無法得到病患臨床生理指標、合併症等因素有關，此有待更完善資料收集與研究。 城鄉在創傷的比較上，的確存在著差異，降低城鄉間的創傷醫療差異，仍有賴國人進一步努力。

關鍵字

交通事故嚴重度 ； 整體檢傷表現 ； 住院天數 ； 死亡率 ； 城鄉差異

並列摘要

Road traffic injury is a heavy burden to a country’s society, economy and health. It was the 9th leading cause of global death and the costs is estimated to be 518 billion US dollar per year. The unintended injury death has been the 5th leading cause in Taiwan in recent years. The road traffic injuries play the key part within it. By linking the National Traffic Accident Investigation Reports（police database）, the Bureau of National Health Insurance database, and the death registration database in central Taiwan, this study was aimed :1) to analyze factors associated with injury severity; 2) to assess the overall triage performance; 3) to compare the differences in length of stay and mortality of trauma patients treated in different levels of hospitals and 4) to compare the rural and urban differences in trauma and medical care.
Human factors associated with severe injuries included age older than 30 years old (30-65 years old, >65 years old), alcohol consumption, drive without license. Risk factors for severe injuries in vehicle factors included helmet/set-belt non-use, motorcycle in comparison to car, collision with a fixed object. Environment factors associated with severe injuries were drive at night, higher speed limit (50-80km/h, >80 km/h), non-intersection, signal without proper function and Chang-hau county (in comparison to Tai-chung city).
Triage performance was determined by sensitivity and specificity. Sensitivity was defined as the percentage of major patients treated at medical centers, and specificity was defined as the percentage of non-major trauma patients treated at non-center hospitals. For central Taiwan, the overall sensitivity was 30.61% and the specificity was 77.04%. The overtriage performance was highest for Tai-chung city, followed by Chang-hua county and Nan-tou county, and lowest for Tai-chung county. The undertriage performance was highest for Tai-chung county, followed by Nan-tou county and Chang-hua county, and lowest for Tai-chung city. There was no difference in undertriage rates between Chang-hua county and Tai-chung city. When triage performance was evaluated against regional hospital and higher vs. district hospital, the sensitivity was 83.45% and the specificity was 28.52%. The overtriage performance was highest for Tai-chung city, followed by Chang-hua county and Nan-tou county, and lowest for Tai-chung county. The undertriage performance was highest for Nan-tou county, followed by Tai-chung county and Chang-hua county and lowest among Taichung city.
The length of stay was longest for medical center, followed by regional hospital, and district hospital. Other factors affecting length of stay included fatality, severity, sex, age, license, county, vehicle type, night, speed limit and crossing county hospitalization. Thirty-day mortality was higher in medical center and regional hospital than in district hospital. Factors such as rural/urban, sex and alcohol consumption also affected 30-day mortality.
There were significant different between rural and urban events with regards to the number of death on scene, the overall triage performance and the 30-day mortality Compared to urban events, rural events had higher number of death on scene, and higher 30-day mortality, lower sensitivity, and high specificity There was no difference in length of stay between rural and urban events.
Prevention is better than cure. To eliminate factors associated with severe injuries might reduce the life loss. The overall triage performance in central Taiwan was suboptimal and there were gaps in triage performance between cities/counties in central Taiwan. We have to make effort in remodeling trauma care system to improve the triage performance. The length of stay was longer in medical center and the 30-day mortality was higher in medical center. These results could be due to the lack of physiological data, the existence of comorbidity and inadequate adjustment. Efforts should be made to reduce the differences between urban and rural events.

並列關鍵字

road traffic injury ； traffic injury severity ； overall triage performance ； length of stay ； mortality ； rural and urban

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