中台灣嚴重外傷病患死亡率相關因素探討：對外傷登錄與外傷體系之意涵

Mortality Factors for Major Trauma in Central Taiwan: Implications for Establishing a Trauma Registry and Trauma System

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)

《醫護科技期刊》 12卷2期 (2010/06) Pp. 96-108

https://doi.org/10.6563/TJHS.2010.12(2).3

摘要

本研究以中部某醫學中心2005年7月至2008年6月的外傷登錄資料庫爲分析對象，瞭解嚴重外傷病患屬性，探討嚴重外傷病患死亡的影響因素。以邏輯斯迴歸模型統計生理條件、受傷條件、與治療條件與嚴重外傷病患治療結果的相關性。研究結果發現年齡每增加1歲，死亡勝算增加29%；到院時有不穩定生理指標者的死亡勝算比爲5.7；外傷嚴重度(ISS)每增加1分，死亡勝算增加12.4%；治療過程有併發症者的死亡勝算比爲2.48；昏迷指數小於13分的生理指標、轉診到院與到院後48小時內死亡有顯著相關，死亡勝算比分別爲12.19和3.34。年齡、不穩定生理指標、外傷嚴重度(ISS)、頭頸部嚴重外傷、併發症顯著影響嚴重外傷病患的治療成效，嚴重外傷的早期與晚期死亡的影響因素有差異。因此維持穩定生命徵象、以及爭取治療時效與減少併發症的發生，是嚴重外傷病人臨床處置的最重要準則。此一結果的政策意涵在本文中有深入的討論。

關鍵字

嚴重外傷 ； 外傷醫療體系 ； 外傷登錄 ； 死亡率 ； 危險因子

並列摘要

This investigation explores pattern and risk factors of mortality associated with major trauma. A trauma registry dataset from a medical center was used to analyze mortality factors for major trauma via logistical models. The likelihood of mortality increased by 2.9% with each year of patient age. Furthermore, the odds of mortality increased by 12.4% with each one point increase in injury severity score. Other mortality factors include unstable vital signs on arrival (OR=5.69), and complications during trauma care (OR=2.48). Patients with Glasgow Coma Score below 13 (OR=12.19), and transferred patients (OR=3.34) were significantly associated with early mortality defined as occurring within 48 hours after injury. Age, unstable vital signs, injury severity score, severe head and neck injury and complications were risk factors associated with mortality from major trauma. Risk factors differed between mortality within and beyond 48 hours following admission. Maintaining stable vital signs, making appropriate decisions during the initial phase and reducing complications are the most important guidelines for optimizing care of major trauma patients.

並列關鍵字

Major trauma ； trauma system ； trauma registry ； mortality ； risk factor

參考文獻

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