頭部外傷病人接受電腦斷層之盛行率與醫療資源耗用及其影響因子

目的電腦斷層可以使用在多方面，包括醫療、考古、鑑識、藝術等，當然醫療還是最普及的範疇。近年來，電腦斷層的使用量，於醫療的各科別都快速上升，而頭部外傷的評估尤其需要電腦斷層的輔佐。面對如此迅速增加的電腦斷層使用量，所以本研究欲對台灣急診頭部外傷病人的電腦斷層使用做出趨勢分析。材料與方法本研究為回溯性世代研究，資料來自於2006年到2011年的台灣全國性資料庫，對於台灣急診頭部外傷患者的電腦斷層使用情形，進行描述性與推論性分析。主要結果以勝算比(Odds Ratio)呈現。結果 6年的研究期間，共有41816人次頭部外傷急診病人，這其中電腦斷層使用改變率為上升 41.71%，同一期間，每年頭部外傷急診病人數並未有趨勢性的改變。這段期間，電腦斷層在頭部外傷患者的使用增加1.6倍 (Odds Ratio：1.60; 95% CI：1.49 to 1.72)，可能性的增加在80歲以上的族群最為顯著，達6.79倍 (Odds Ratio：6.79; 95% CI：6.09 to 7.58)，接下來分別是65~79歲 (Odds Ratio：4.83; 95% CI：4.44 to 5.25) 及50~65 歲 (Odds Ratio：3.18; 95% CI：2.96 to 3.41)。年代、男性、共病症數及醫院層級別對電腦斷層於頭部外傷病人的使用皆有正相關；急診主治醫師的年資則無影響。經由急診住院的頭部外傷病人，醫療費用與年份、年齡、男性、共病症數及醫學中心有正相關，與住院時之主治醫師年資無關；住院天數與年齡、男性、共病症數及醫學中心有正相關，與年份、住院科別及主治醫師年資無關。討論急診頭部外傷的電腦斷層檢查率明顯上升，且在高齡族群增加明顯，相符於近年的國際建議準則，過去研究多在幼年族群發現電腦斷層曝露的可能輻射傷害，本研究顯示近年台灣對18歲以下族群的電腦斷層檢查率並未增加。結論電腦斷層在急診頭部外傷的病人使用，隨著時間增加，高齡是造成增加的最主要原因。

關鍵字

電腦斷層；頭部外傷；急診

並列摘要

Purpose The role of computed tomography (CT) in Traumatic Brain Injury (TBI) has increased substantially in recent years and we conduct a nationwide population study to evaluate the temporal trends in Taiwan. Materials and Methods This retrospective nationwide study analyzed administrative claims data obtained from the Taiwan Bureau of National Health Insurance (BNHI) from 2006 to 2011. We assessed changes during this period in CT use of ED TBI patients. Main outcomes were presented as adjusted risk ratios (RRs). Results Data from 41816 TBI visits during the 6-year period yielded the rate of CT use increased 41.71% without increased TBI patients (Fig1). After multivariable adjustment, the overall likelihood of CT use over time was 1.60-fold (adjusted RR 1.60; 95% CI 1.49% to 1.72%) (Table 1). Rate of growth were highest in more than 79 year-old group (adjusted RR 6.79; 95% CI 6.09% to 7.58%),the next two group were 65-79 year-old (adjusted RR 4.83; 95% CI 4.44% to 5.25%) and 50-64 year-old (adjusted RR 3.18; 95% CI 2.96% to 3.41%) . No significant influence was found in gender, comorbidity, hospital level and ED physician seniority (Table 2). From 2006 to 2007 and 2010 to 2011, there were decrease rate in less than 18 year-old group (Figure 2). The cost of admitted TBI via ED had no significant change during the six years, neither in the different age groups. Cost increased in the more severe cormobidity; it decreased in female, lower hospital level and senior ED physician (Table 3). Discussion Despite long-standing awareness about the harm of ionization radiation and prediction rules designed to minimize neuroimaging in minor head injury, head CT use for traumatic brain injury patients still increased(1). Emergency physicians should continue to apply evidence-based guidelines for neuroimaging, and should consider strategies to maximize use of validated prediction rules to minimize unnecessary radiation and cost associated with head CT use (2). Conclusion CT utilization increased over time in the ED TBI patients and elderly accounts for the main cause of increasing use. The seniority of emergency physicians can decrease TBI hospitalization cost.

並列關鍵字

Computed Tomography ； Traumatic Brain Injury ； Emergency Department

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頭部外傷病人接受電腦斷層之盛行率與醫療資源耗用及其影響因子

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