急診檢傷應用於腹部臟器損傷病患等候外傷處置時間、住院日數與死亡

The Application of Triage on Waiting Time for Treatment, The Length of Stay and Mortality for Patients With Abdominal Trauma

目標：急診檢傷是指病患進入急診時，依病患疾病嚴重度，區分建立就診優先順序，使病患在有效時間內，獲得適當的照護。本研究探討急診檢傷對腹部臟器損傷病患等候外傷處置時間、住院天數及住院死亡之影響。方法：本研究以南部某重度級急救責任醫院之外傷登錄系統資料庫為資料來源，分析2009年1月至2014年12月因外傷需啟動外傷小組之腹部實質臟器損傷急診病患資料，外傷嚴重度分數（injury severity score, ISS）16分（含）以上共176人。以敘述性統計（平均值、標準差、百分比）分析人口學特性、外傷情形與處置及住院天數與住院死亡；以單因子變異數分析及卡方檢定分析病患人口學特性、等候外傷處置時間、住院天數與住院死亡於不同急診檢傷級數之差異；以迴歸分析探討不同檢傷級數病患性別、年齡與外傷嚴重度分數對等候外傷處置時間、住院天數及住院死亡之影響。結果：腹部臟器損傷病患平均年齡45.7歲，男性為主（59.1％）；ISS平均27.6分（ISS 25分：52.8％）；平均住院天數14.8天；檢傷級數第一級64人（36.4％）、第二級80人（45.5％）、第三級24人（13.6％）、第四級8人（4.5％）；住院死亡率10.2％。檢傷一級，患者年齡每增加1歲，於急診停留等待接受動脈血管栓塞術增加10.63分鐘；外傷嚴重度每增加1分，住院死亡風險增高1.11倍。檢傷四級，患者外傷嚴重度每增加1分，住院日數增加1.02天。結論：不同急診檢傷級別影響患者等候外傷處置時間、住院天數及住院死亡的因素有所差異。

Objectives: Emergency department (ED) triage is performed to prioritize care for patients with critical illness. This study explores the effects of ED triage on waiting time for treatment, the length of stay and mortality for patients with abdominal trauma. Methods: Data regarding emergency patients with severe abdominal trauma and injury severity score (ISS) equal to or greater than 16 were acquired from a trauma registry dataset in a First Aid responsibility hospital in southern Taiwan. The duration of study was from January 2009 to December 2012, and a total of 176 patients qualified for this study. Descriptive statistics (mean, standard deviation and percentage) were used to analyze the characteristics, trauma situations and treatments, prognoses. One-way ANOVA, χ^2 test and regression models were applied to estimate the effects of triage on waiting time for treatment, the length of stay and mortality for patients with severe abdominal trauma. Results: The mean age was 45.7 years, male was the major (59.1%), mean ISS was 27.6 points (ISS 25 was 52.8%), average length of stay was 14.8 days, patients with level 1, 2, 3 4 triages were 36.4% (64 patients), 45.5% (80 patients), 13.6% (24 patients) and was 4.5% (8 patients), respectively, and mortality was 10.2%. Level 1 triage, the waiting time for transcatheter arterial embolism delayed 10.63 minutes with patient's age increased 1 year. Moreover, the mortality increased 1.11 times with the score of ISS increased 1 point. Level 4 triage, the length of stay increased 1.02 days with the score of ISS increased 1 point. Conclusions: In different ED triage, the factor affects abdominal trauma patient on waiting time for treatment, the length of stay and mortality could be different.