頭部外傷原因與醫療資源耗用

Head Injury: Causes and Medical Resources Utilization

王雅玲(Ya-Lin Wang) ； 黃崇謙(Chung-Chien Huang) ； 楊啟賢(Chi-Hsien Young)

《北市醫學雜誌》 3卷11期 (2006/11) Pp. 53-64

https://doi.org/10.6200/TCMJ.2006.3.11.06

摘要

目的：事故傷害所導致頭部外傷一直是世界關注的公共衛生議題，造成潛在生命（Years of Potential Life Lost，簡稱YPLL）損失遠比癌症、心血管疾病嚴重。方法：本研究係以健保局台北分局歸戶後住院醫療費用資料檔，排除無效診斷後經醫院疾病分類管理師補填外因碼並串聯衛生署死亡檔，針對2000年－2004年大台北區域頭部外傷住院事件為期五年次級資料之人口族群回溯性分析，探討不同傷害原因類型所衍生醫療耗用。結果：本研究收集為期五年頭部外傷住院43,239人，其中81.4%屬中壯年與青少年，平均年齡43.3歲（男性42.7歲、女性44.3歲），平均住院11日（男性11.9日、女性9.4日、老人（65歲以上）18.2日，住院死亡率6.38%（男性7.49%、女性4.70%、老人14.13%），總住院醫療耗用2,799,103,526元，平均每人64,736元（男性73,685元、女性49,933元、老人平均每人116,394元）。分析傷害原因(1)機動車交通事故佔53.3%最多，平均39.3歲，平均住院10.7日、住院死亡率5.8%、平均每人63,242元；機車事故平均年齡31.3歲，平均住院9.9日、平均每人58,016元、住院死亡率4.5%、死亡個案平均每人184,646元。(2)意外墜落事故佔31%是造成頭部外傷第二位原因，平均55.9歲較高、平均住院15.7日、平均每人100,111元、住院死亡率10.4%，死亡個案平均每人284,801元，皆高於機動車交通事故。結論：中壯、青少年是機動車事故高危險群外，老人是另一好發族群。高齡化社會的老人意外墜落應予重視，無論何種事件終造成高額住院醫療資源耗用。從安全促進觀點：如果瞭解可能的風險行為(risk behavior)，針對年齡風險特性擬定防範策略，持續推動機動車交通安全重點外，老人意外墜落事件也不容忽略；與疾病治療相較之傷害防制有著正面生命意義與貢獻，衛生機關應針對各類傷害危險因子研擬防範政策及有效分配使用醫療資源。

關鍵字

頭部外傷 ； 傷害原因 ； 醫療資源耗用 ； 機動車交通事故 ； 意外墜落

並列摘要

Background and Purpose: Head injuries caused by unintentional and intentional incidents remain a global concern in the public-health agenda. The Years of Potential Life Lost (YPLL) resulting from such head injuries would appear to be much greater than corresponding numbers lost to cancers or to various cardiovascular diseases. Methods: This study is a population-based investigation of head injuries combining the total annual inpatient dataset acquired from The Bureau of National Health Insurance (BNHI), Taiwan, during the years 2000 to 2004 inclusively, and the domicile files of death certification issued by the Department of Health (DOH), Taiwan, this aspect of the research focusing, retrospectively, on analysis of the last five years of records for such head injuries. The impacts of the Mechanism of Injury (MOI), inpatient characteristics' distribution, and the medical resources utilized for treatment of such patients are analyzed herein. Results: An analysis of the relevant individual medical records for 43,239 head-injury patients over the period 2000 to 2004 inclusively suggested that the total hospitalization expense for such patients was NTD 2,799,103,526 with the average patient age being 43.3 years. The Average Length of Stay (LOS) in a medical institution was 11 days, and the average per-patient hospitalization expense was NTD 64.736. Traffic accidents accounted for 54.8% of the total patient number, and such injuries appeared to be concentrated amongst youth and teenagers, with an average age of 38.3 years, such individuals revealing an average per-person hospitalization expense of NTD 62,797. Amongst such a population, there were 17,996 persons (53.3%) who were victims of Motor Vehicle Traffic Accidents (MVTA) such individuals featuring an average age of 39.3 years, 10.7 days of LOS, an inpatient mortality rate of 5.8% and an average per-person hospitalization expense of NTD 63,242. Accidental falls was the second most-common mechanism of head MOI incorporating 10,486 persons (31%), featuring a greater average age of 55.9 years, as compared to traffic-accident victims, 15.7 days of LOS, a mortality rate of 10.4% and a larger average per-person hospitalization expense (NTD 100,111) than was the case for traffic-accident victims Accidental falls amongst elderly people would appear to be an emerging issue which clearly cannot be overlooked in an aging society such as is the case for Taiwan. Conclusion: Given the evidence presented herein, a nation's clinical services and health policymakers should allocate an appropriate level of medical resources in order to effectively deal with different injury patterns.

並列關鍵字

Head injury ； Medical-resources utilization ； Mechanism of Injury MOI ； Motor Vehicle Traffic Accidents MVTA ； Accidental falls