| Summary: | 碩士 === 國立中山大學 === 醫務管理研究所 === 101 === Major trauma refers to an injury with an injury severity score (ISS) equivalent to or greater than 16. In 2009, the Department of Health, Executive Yuan, included quality of care for patients with major trauma as a required item for the grading and evaluation of hospitals’ emergency medical competency.
The trauma registry database and National Health Insurance (NHI) claim data from an emergency response hospital in Southern Taiwan was used in this study. According to retrospective analysis, among the patients admitted to the emergency unit because of trauma between January 2010 and December 2011, 452 matched the criterion of major trauma with an ISS≥16. Based on relevant factors such as patient characteristics, condition of trauma, and trauma first aid, this study examined the differences in patients’ general length of stay (LOS), intensive care LOS (ICULOS), and medical costs.
The research results indicate that these major trauma patients were primarily middle-aged men with an average age of 47. The most common mechanism of trauma was primarily blunt force trauma, and 45% were transferred from other hospitals. The traumatized sites in most cases were the head and neck, and three-fourths of the patients possessed at least two traumatized sites. Among the patients admitted for major trauma, 35% exhibited extremely severe trauma (ISS≥25), and 56 died following hospitalization (12.4% mortality rate). The majority of the patients received imaging examinations, and two-thirds received surgical therapy. The average LOS was 19.6 days, and the average ICULOS was 8.7 days. The average cost per admission was NT $269,259.40, in which emergency medical fees accounted for NT $23,795.7.
Relevant factors that influenced LOS includes the method of admission, severity of trauma, death during hospitalization, and surgery; whereas only the severity of trauma and surgery were relevant factors that affected ICULOS. Relevant factors that influence medical costs include mechanism of trauma, severity of trauma, and surgery. Factors that influence hospitalization costs include gender, mechanism of trauma, severity of trauma, and surgery. Numerous relevant factors affect emergency medical costs, including age, the total number of traumatized sites, severity of trauma, death during hospitalization, imaging examinations, and surgery. Among these factors, ISS score, surgery, and abdominal trauma all significantly increased all medical resource usage.
This study recommends that the Department of Health reference international trends and update the domestic ISS and scoring calculation guidelines to match the latest international standards. The revised ISS can be effectively used as a reference to evaluate patients’ severity of trauma. For NHI, patients who exhibit major trauma should be further divided into groups of severe (ISS between 16 and 24) and extremely severe (ISS≥25). Different medical payment plans should be provided to patients based on their level of care.
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