Investigating Epidemiology of Trauma and Developing Optimal Trauma Care System in Taiwan

Abstract

Injuries bring many deaths every year in both Taiwan and globally In 2017 accident is the 6th leading cause of the death in Taiwan The average loss of life of years is 24 4 for accidental deaths and 23 8 for suicide compared with 15 3 in all deaths The trauma is actually the most important cause of death in younger people and improvement of trauma care can save a large amount of years of life Good trauma care system will decrease the mortality of trauma patients Trauma care system was standardized by hospitals emergent ability accreditation in Taiwan since 2007 We experienced the new era of trauma care of National Cheng Kung University Hospital (NCKUH) since 2009 We built trauma registry data and setup an integrated trauma team and hope to decrease the mortality rate In this study we have two objectives: investigating clinical characteristics of cases of head trauma and hip fracture; assessing of the influence of trauma team on survival of trauma patients We used the trauma registry data of NCKUH set in and thereafter 2009 and compared the mortality rate of trauma patients before (2009-2010) and after trauma team setup We performed jointpoint regression to assess whether there is a reflection in mortality rate in relation to the setup of trauma team We also used Taiwan’s National Health Insurance Research Database in 2007~2008 for head injury epidemiology (before hospitals emergency ability accreditation) and between 2000~2012 for hip fracture (because of low mortality and long term follow up) epidemiology We used binary logistic regression model to estimate the odds ratios (ORs) and their 95% confidence interval (CI) of mortality in association with selected risk factors Among 7 433 patients trauma patients admitted to NCKUH in 2009-2013 266 died (3%) in hospital with a higher mortality rate in 2009-2010 than in 2011-2013 (3 9% vs 2 7%) The decline of mortality rate over time is more obvious in female patients than in males After adjustment for potential confounders patients admitted after trauma team set experienced a lower but insignificantly reduced odds of mortality (OR: 0 58 95% CI: 0 16-2 12); and such reduced mortality odds was especially notable for those patients with Injury Severity Scores >=25 Based on the nationally representative sample we found that the hospitalization rate for all head injury was 215 3 per 100 000; and for moderate-to-severe head injury it was 105 9 per 100 000 We noted that patients who resided in rural areas had a higher hospitalization rate than those residing in urban areas (130 6 vs 95 3 per 100 000 respectively; pQ1-Q3: OR: 0 91 95% CI: 0 87-0 95; >Q3-Max : OR: 0 80 95% CI: 0 75-0 85) Integrated trauma team is very important in a hospital but it appears that it only poses beneficial influence among very severe cases It may be caused by low mortality rate of minor injury or well established trauma care in hospitals We need more studies to find the other potential impacts of trauma team The National Health Insurance covered all the Taiwan population and improve the socioeconomic inequality in health care but we still found that low income and rural area were associated with higher mortality in head injury and 1-year of hip fracture We need to investigate the underlying factors truly contributed to such urban-rural difference and to formulate strategies that can effectively reduce such socioeconomic inequality Trauma care is not only a medical problem but also a socioeconomic issues Good medical service is relied on hospital accreditation and provision of good quality of care Although the implementation of universal coverage of health insurance has largely removed barriers to health care in Taiwan further reduction of socioeconomic inequality in health care should be considered by both clinicians and health policy makers

Date of Award	2018 Aug 10
Original language	English
Supervisor	Chung-Yi Li (Supervisor)