入院72小時昏迷指數改善對嚴重頭部外傷病患的死亡率、失能率及醫療花費的影響

Abstract

研究背景：嚴重頭部外傷常常造成相當高的死亡率和失能率，本研究針對嚴重頭部外傷病患，探討以治療72小時後的昏迷指數作為二分法的指標，能否推估何組病患對積極治療的效果較好。 研究方法：本研究採回溯分析的方式，從台灣一家重度急救責任醫院2010年8月1日到2016年6月30日232位嚴重頭部外傷病患的資料中，共納入90位病患並分為兩組：35位為“進步組”（72小時後昏迷指數大於8分），55位為“非進步組”（72小時後昏迷指數小於等於8分）。本研究分析比較兩組間的死亡率、醫療花費和六個月的功能性預後。 研究結果：進步組的病患相較於非進步組有較低的住院中死亡率(11.4% and 54.4%, p<0.05)。進步組中存活的病患其住院天數與醫療花費大約是非進步組中存活病患的一半（住院天數：平均33.5天和62.9天，p<0.05；醫療花費：平均290,781元新台幣和624,034元新台幣，p<0.05）。進步組相較於非進步組有較高比率（72%和13%，p<0.05）的病患有較好的功能性預後（追蹤六個月，格拉斯哥預後指數（GOS）4分和5分） 討論：本研究顯示嚴重頭部外傷病患治療72小時後的昏迷指數可作為一項指標，用於推估病患的預後，兩組病患在死亡率、六個月的功能性預後和醫療花費等方面均有顯著差異。

Background: Patients with severe traumatic brain injury (TBI) often results in high mortality or disability rate. This study proposes a dichotomy by Glasgow Coma Scale (GCS) at 72 hours to predict which categories of TBI patients may better respond to aggressive treatments. Methods: A retrospective review of 232 patients with severe TBI was performed in a level one trauma center in Taiwan, from August 1, 2010 to June 30, 2016. Ninety patients were included and divided into two groups: 35 in the “improved group” (GCS >8 at 72 hours) and 55 in the “non-improved group” (GCS 8 at 72 hours). The mortality rate, 6-month functional outcome and medical costs between the two groups were investigated. Results: Patients in the improved group had a lower in-hospital mortality rate, compared to those in the non-improved group (11.4% and 54.4%, p<0.05). The length and medical costs of hospitalization for survived patients in the improved group were approximately half of those in the non-improved group (hospital stay: mean 33.5 days and 62.9 days, p<0.05; costs: mean 290,781 NTD and 624,034 NTD, p<0.05). Patients in the improved group showed a higher rate of having favorable functional outcomes (GOS 4 and 5) after 6-month follow up, compared to those in the non-improved group (72% and 13%, p<0.05). Discussions: Our study suggests using GCS score at 72 hours as a parameter to estimate what categories of severe TBI patients may better respond to aggressive treatment, in terms of mortality rate, functional outcome, length of hospitalization and medical cost.