以急診室外傷登錄系統評估重大外傷死亡率之危險因子及外傷小組介入之臨床效益

Risk factors of mortality assessment in trauma registry system and clinical effectiveness of trauma team intervention in Emergency Room

陳智豪(Chih-Hao Chen)

指導教授 ： 林隆堯

中山醫學大學/醫學院/醫學研究所/碩士(2014年)

https://doi.org/10.6834/CSMU.2014.00177

摘要

背景:外傷類型及其嚴重度會影響醫療支出及病人死亡率,外傷登錄系統 可有效整合外傷病人的臨床數據,進而達到傷害防制、政策發展,以及改 善醫療品質的功能。 目的:本研究旨在利用急診室外傷登錄系統評估重大外傷病人的七天內死
亡風險,以及外傷小組介入的臨床效益。 方法:本文採用回溯性世代研究法探討重大外傷病人的七天內死亡風險及 外傷小組介入的臨床效益,研究對象為中部某醫學中心急診重大外傷病 人,研究時間為 2008 年 1 月至 2009 年 12 月。病人傷勢分級以外傷嚴重度 分數(Injury Severity Score, ISS)進行評估,ISS≧16 分者視為重大外傷。 Kaplan-Meier test 及 Cox-regression 進行重大外傷病人的存活分析,統計顯 著水準 α 值設為 0.05。
結果:2008-2009 年的急診外傷病人數為 18,682 人,前三大就診原因依序 為交通事故 8,841 人(47.3%)、家庭事故 5,043 人(26.9%)及職業災害 1,725 人(9.2%),重大外傷病人則有 240 人(1.3%)。重大外傷病人的七天內死亡風 險因子主要為外傷嚴重度分數(平均 62.1 分,p<0.001);外傷小組介入之重 大外傷病人的七天內死亡風險略低,但未達統計上的顯著水準(p=0.140)。 結論:外傷嚴重度分數可作為重大外傷病人死亡風險的預測指標,外傷小 組的臨床效益雖然未如預期,但它仍是救治重大外傷病人的重要機制,建 議以更大規模的研究進行外傷小組的臨床效益評估,以增進緊急救護重大 外傷病人的功能。

關鍵字

外傷登錄系統 ； 外傷嚴重度分數 ； 外傷小組 ； 重大外傷

並列摘要

Background: The type and severity of the traumatic patients will affect medical costs and their mortality. Trauma registration system effectively integrate clinical data of patients with trauma, and then to impact on injury prevention, policy development, and medical quality improvement.
Objective: We aim at using trauma registration system of emergency room to evaluate the death hazard ratio of patients in seven days and the clinical benefit of trauma team intervention.
Methods: From January 2008 to December 2009, a retrospective cohort study design was introduced into the period. The eligible emergency trauma patients of a medical center of Middle Taiwan were enrolled in this study. The degree of trauma was categorized by Injury Severity Score (ISS). The severe trauma was
defined as patient with Injury Severity Score equal to sixteen and more.
Kaplan-Meier test and Cox-regression were used to analyze the survival of severe trauma patients and a significant level of alpha-value was set at 0.05.
Results: There were 18,682 trauma patients emergency visited our hospital in the period of this study. The first three major reasons of emergent visit were traffic accident (47.3%), home accident (26.9%) and occupational injury (9.2%). In all, there were two hundred and forty severe trauma patients. The major risk factor of death within 7-days for trauma patients was the disappointing Injury Severity Score (mean 62.1; p<0.001); the intervention of trauma team presented a non-significant statistical effect on patients’ survivals (p=0.140).
Conclusions: The ISS serves a predictor of mortality risk of severe trauma patients. Clinical effect of trauma team, although not as expected, is still an important mechanism to manage severe trauma patients. We suggest large-scale study to enhance the effectiveness of trauma team and to improve ability of emergency care for severe trauma patients.

並列關鍵字

trauma registration system ； Injury Severity Score (ISS) ； trauma team ； severe trauma.

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