成人酒後外傷與創傷嚴重度及醫療費用支出之關聯性

The association of alcohol intoxication and trauma injury severity and medical expenditure in adults

彭淑惠(Shu-Hui Peng)

指導教授 ： 謝青華 ； 鄭雅愛

義守大學/醫學院/醫務管理學系/碩士(2017年)

摘要

研究目的：與喝酒相關之創傷，不管是酒駕、酒後鬥毆、或是酒後跌倒等，一直是導致外傷的主要原因之一。酒後外傷是否會因為控制力不佳更容易受傷而合併較低之創傷嚴重度，還是相反地會合併更嚴重之創傷，目前尚無定論。再則酒後外傷是否會增加醫療費用之支出也是一個有趣之議題。因此我們想藉由這個研究，試圖去找出成人酒後外傷與創傷嚴重度及醫療費用支出之關聯性，提供客觀之證據，以建立更完備的治療參考。
研究方法：此回溯性研究，將調閱了南部某醫學中心外傷科的病歷紀錄及外傷登錄之資料，病歷調閱的時間由2009年01月01日至2014年12月31日止，納入研究的條件是20至65歲成年病患因外傷至本院急診就醫並住院之患者。排除條件為外傷登錄資料不完全之病患及疑似有喝酒但拒絕酒測之病患。將所有調閱出來的病例依照酒精中毒(血清酒精濃度≧50 mg/dL之病患)、無酒精中毒(血清酒精濃度＜50mg/dL及不頇接受酒測之病患)分為兩組，使用SPSS及傾向分數(propensity score)成偶配對法做兩組之間各項之統計分析比較。
研究結果：本研究共收案11,033名創傷病患，其中酒精中毒病患為929人，無酒精中毒病患為10,104人。與無酒精中毒病患相比，酒精中毒病患男性較多，女性較少，平均年齡較輕，有高血壓、糖尿病、或腎衰竭等原有疾病之人較少，機車比汽車車禍者較多，但跌倒比撞擊物體或物體撞擊者較少，受傷部位在頭部、臉部、胸部者較多，昏迷指數較低(12.6 3.7比14.5 1.9分，p＜0.001)，外傷嚴重度分數較高(30.8 17.8比7.7 6.5，p＜0.001)，死亡率較高(3.6%比1.2%，p＜0.001)，住院天數(11.4天比9.1天，p＜0.001)及加護病房住院比例(35.4%比15.0%，p＜0.001)皆較多。與無酒精中毒病患相比，酒精中毒病患住院之總醫療費用高28.3%、手術費用高51.8%、檢查費用高71.7%、藥費高63.8%。即便經傾向分數(propensity score)成偶配對法(matching)後挑選出性別、年齡、及原有疾病相匹配之酒精中毒病患和無酒精中毒病患相比較，可以發現酒精中毒病患之平均接受手術次數較多(1.5次比1.3次)，其住院之總醫療費用高17.4%、手術費用高40.3%、檢查費用高52.8%、藥費高38.3%。
結論：酒後外傷會合併更嚴重之創傷並增加醫療費用之支出。因此如何降低及避免酒後外傷，尤其是酒後汽機車之行駛，以減少相關之併發症及醫療費用支出，將是在外傷防治之一個重要關鍵。

關鍵字

外傷登錄 ； 成人外傷 ； 血清酒精濃度 ； 酒精中毒 ； 外傷嚴重度分數 ； 昏迷指數 ； 死亡率 ； 醫療費用

並列摘要

BACKGROUND: Alcohol-related trauma, which including drunk driving, fighting or a fall after drinking alcohol, is the main reason for sustaining trauma injury. Because the drunken patient has a poor control and may tend to be involved in an accident and sustain a lower or, in contrast, a higher injury severity, it is not yet determined in the relationship between alcohol use and the severity of trauma. Furthermore, it is interesting to clarify whether there is higher medical expense associated with alcohol-related trauma injury. To provide objective evidences and more complete therapeutic algorithm, this study was designed to investigate the relationship of alcohol-related trauma and the injury severity as well as medical expenses in adults.
MATERIALS AND METHODS: A retrospective study of the medical records and registered data in Trauma Registry System from 2009 to 2014 was performed at a medical center in southern Taiwan. The inclusion criteria included all patients aged from 20 to 65 years and admitted via emergency department. Those who had incomplete registered data and those who were suspected drunken but refused an alcohol test were excluded. The patients whose blood alcohol concentration (BAC) level≧50mg/dl was considered as alcohol intoxication group while those whose BAC level less than 50mg/dl and those who were not required for an alcohol test were deemed as patients without alcohol intoxication group. SPSS statistical method and propensity score matching were used to compare these two groups.
RESULTS: Of the total 11,033 adult patients, 929 patients with BAC (+) and 10,104 patients with BAC (–) were enrolled in this study. Patients with alcohol intoxication were predominantly men, of younger age, and had lower incidence of pre-existing comorbidities and chronic diseases such as hypertension, diabetes, and end-stage renal disease. In addition, more patients with alcohol intoxication were injured in motorcycle and motor vehicle accidents than those without alcohol intoxication. In contrast, a smaller number of patients with alcohol intoxication were injured in strike by/against objects and fall accidents. Patients with alcohol intoxication had significantly higher rates of head/neck injury, face injury, thoracic injury, and abdomen injury, lower Glasgow coma scale (GCS) score (12.6±3.7 vs. 14.5±1.9, p＜0.001), higher injury severity score (30.8±17.8 vs. 7.7±6.5, p＜0.001), higher short-term mortality (3.6% vs. 1.2%, p＜0.001), longer hospital stay (11.4 days vs. 9.1 days, p＜0.001), and higher proportion of admission to the intensive care unit (ICU) (35.4% vs. 15.0%, p＜0.001) than those without alcohol intoxication. On comparison with patients without alcohol intoxication, those who had alcohol intoxication spent a significantly higher total expenditure (28.3% higher), cost of operation (51.8% higher), cost of examination (71.7% higher), and cost of pharmaceuticals (63.8% higher). On comparing the selected well-balanced pairs of patients with and those without alcohol intoxication, who had similar personal characteristics regarding sex, age, and co-morbidities, those who had alcohol intoxication still had significantly higher total expenditure (17.4% higher), cost of operation (40.3% higher), cost of examination (52.8% higher), and cost of pharmaceuticals (38.3% higher).
CONCLUSION: Alcohol-related trauma is associated to a higher injury severity and increase the cost of medical expenses. Therefore, how to lower and avoid alcohol-related trauma, particular the drunk driving, to decrease the associated complication and medical expenses would be an important key role in trauma prevention.

並列關鍵字

Trauma Registry System ； Adult trauma ； Blood alcohol concentration (BAC) ； Alcohol intoxication ； Injury Severity Score (ISS) ； Glasgow coma scale (GCS) ； Mortality ； Medical expenses

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