The discussion of medical utilization and mortality in patients with abdominal organ injury by trauma team system

• Main Authors: Chang,Hui-Ju, 張惠茹
• Other Authors: Hwang,Su-Lun
• Format: Others
• Language: zh-TW
• Published: 2018
• Online Access: http://ndltd.ncl.edu.tw/handle/xrub8q

碩士 === 長庚科技大學 === 護理系碩士在職專班 === 106 === ABSTRACT Background：According to the top 10 causes of death in Taiwan in 2015, "accidental injuries" is the sixth leading cause. It is the major cause of mortality for people under 65 year-old. The quality of major trauma care was adopted as an essential item for the grading and assessment of emergency medical capabilities in hospitals by the Health and Welfare Department in Taiwan since 2009. "Major trauma" means that the Injury Severity Score (ISS) greater ≧ 16 points. Most traumatic patients are young and mid-age adults with the highest socio-economic productivity. These unexpected accidents result in the family lost the main source of income and pose the heavy burden. Therefore, reducing the mortality related to trauma and medical utilization will be a very important issue in the medical care system. Methods：In this study, we used the database of (Traumatic Brain Injury, TBI) trauma in the first-rate emergency-response hospital in Chiayi City. From January 2009 to December 2014, all trauma patients were reviewed by medical record to include 176 people with ISS ≧ 16 points and abdominal organ injury. The characteristics of patients, traumatic conditions, treatments and other related factors, the initiation of trauma teams for the time to emergency computer tomography room, time for emergency arterial embolization in the angiography room, time to the operating room, time in the emergency room, and stay in hospital days (including the intensive care unit)were analyzed. We tried to find the effect of activating trauma team in the mortality of patients with major traumatic abdominal injury undergoing emergency arterial embolization and emergency surgery. The statistical methods included independent sample t-test, chi-square test, Pearson product difference correlation, point two series correlation analysis, multiple linear regression analysis and logistic regression analysis. Purposes：(1)To compare the time in Emergency room(ER) for receiving computed tomography(CT) scan if activate trauma team in severe abdominal injury patients (ISS≥16) who received emergent transcatheter arterial embolization(TAE) or emergent surgery; (2) To compare the time in ER for arriving at angiography room and receive emergent TAE if activate trauma team in severe abdominal injury patients (ISS≥16) who received emergent TAE or emergent abdominal surgery. (3) To compare the time in ER after key in the operation list and enter the operation room if activate trauma team in severe abdominal injury patients (ISS≥16) who received emergent TAE or emergent abdominal surgery.; (4) To compare the admission duration (including intensive care unit admission) if activate trauma team in severe abdominal injury patients (ISS≥16) who received emergent TAE or emergent abdominal surgery.; (5) To compare the mortality if activate trauma team in severe abdominal injury patients(ISS≥16) who received emergent TAE or emergent abdominal surgery. Results：During the trauma team study in Year 2009 to 2011, it was found that the medical utilization rate of patients with major abdominal organ injury was positively correlated with the systolic blood pressure at arrival of the hospital and the hospitalization day(s), including thedays in the intensive care unit ( r =0.020, p<0.05); showing that the higher the systolic blood pressure at arrival, the more hospitalization days, which is statistically significant. In addition, during the study in Year 2012 to 2014, the trauma team found that the medical utilization rate of patients with major abdominal organ injury was positively correlated with the age of the patient and the waiting time in the emergency room between key-in the the operating procedures to transfer to the operation room (minutes) ( r = 0.222 , p <0.05). It shows that the older the patient is, the longer the duration in the emergency room, is statistically significant. Conclusion：This study helps medical staffs to understand the importance of high quality trauma team, which can improve the efficiency of treating major trauma patients (GCS 9-12) and decrease mortality. In cooperation with professional nursing team, the time spent waiting for examinations and managements can be significantly decreased. It can furthermore decrease medical utilization rate and decline social medical cost then resume patients’ original life and social production value. Keywords：Trauma team, abdominal organ injury, medical utilization rate, mortality