| Summary: | 碩士 === 國立臺灣大學 === 預防醫學研究所 === 97 === Road traffic injury is a heavy burden to a country’s society, economy and health. It was the 9th leading cause of global death and the costs is estimated to be 518 billion US dollar per year. The unintended injury death has been the 5th leading cause in Taiwan in recent years. The road traffic injuries play the key part within it. By linking the National Traffic Accident Investigation Reports（police database）, the Bureau of National Health Insurance database, and the death registration database in central Taiwan, this study was aimed :1) to analyze factors associated with injury severity; 2) to assess the overall triage performance; 3) to compare the differences in length of stay and mortality of trauma patients treated in different levels of hospitals and 4) to compare the rural and urban differences in trauma and medical care.
Human factors associated with severe injuries included age older than 30 years old (30-65 years old, >65 years old), alcohol consumption, drive without license. Risk factors for severe injuries in vehicle factors included helmet/set-belt non-use, motorcycle in comparison to car, collision with a fixed object. Environment factors associated with severe injuries were drive at night, higher speed limit (50-80km/h, >80 km/h), non-intersection, signal without proper function and Chang-hau county (in comparison to Tai-chung city).
Triage performance was determined by sensitivity and specificity. Sensitivity was defined as the percentage of major patients treated at medical centers, and specificity was defined as the percentage of non-major trauma patients treated at non-center hospitals. For central Taiwan, the overall sensitivity was 30.61% and the specificity was 77.04%. The overtriage performance was highest for Tai-chung city, followed by Chang-hua county and Nan-tou county, and lowest for Tai-chung county. The undertriage performance was highest for Tai-chung county, followed by Nan-tou county and Chang-hua county, and lowest for Tai-chung city. There was no difference in undertriage rates between Chang-hua county and Tai-chung city. When triage performance was evaluated against regional hospital and higher vs. district hospital, the sensitivity was 83.45% and the specificity was 28.52%. The overtriage performance was highest for Tai-chung city, followed by Chang-hua county and Nan-tou county, and lowest for Tai-chung county. The undertriage performance was highest for Nan-tou county, followed by Tai-chung county and Chang-hua county and lowest among Taichung city.
The length of stay was longest for medical center, followed by regional hospital, and district hospital. Other factors affecting length of stay included fatality, severity, sex, age, license, county, vehicle type, night, speed limit and crossing county hospitalization. Thirty-day mortality was higher in medical center and regional hospital than in district hospital. Factors such as rural/urban, sex and alcohol consumption also affected 30-day mortality.
There were significant different between rural and urban events with regards to the number of death on scene, the overall triage performance and the 30-day mortality Compared to urban events, rural events had higher number of death on scene, and higher 30-day mortality, lower sensitivity, and high specificity There was no difference in length of stay between rural and urban events.
Prevention is better than cure. To eliminate factors associated with severe injuries might reduce the life loss. The overall triage performance in central Taiwan was suboptimal and there were gaps in triage performance between cities/counties in central Taiwan. We have to make effort in remodeling trauma care system to improve the triage performance. The length of stay was longer in medical center and the 30-day mortality was higher in medical center. These results could be due to the lack of physiological data, the existence of comorbidity and inadequate adjustment. Efforts should be made to reduce the differences between urban and rural events.
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