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| DC 欄位 | 值 | 語言 |
|---|---|---|
| dc.contributor.advisor | 張睿詒 | |
| dc.contributor.author | Ying-Chih Chen | en |
| dc.contributor.author | 陳盈志 | zh_TW |
| dc.date.accessioned | 2021-06-16T09:18:33Z | - |
| dc.date.available | 2022-09-08 | |
| dc.date.copyright | 2017-09-08 | |
| dc.date.issued | 2017 | |
| dc.date.submitted | 2017-07-07 | |
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Journal of clinical epidemiology. 1992;45(6):613-9. | |
| dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/59241 | - |
| dc.description.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。 | zh_TW |
| dc.description.abstract | 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. | en |
| dc.description.provenance | Made available in DSpace on 2021-06-16T09:18:33Z (GMT). No. of bitstreams: 1 ntu-106-R04848025-1.pdf: 963396 bytes, checksum: 8516dac23cf12a836dd49e6872f8d9b6 (MD5) Previous issue date: 2017 | en |
| dc.description.tableofcontents | 論文口試委員審定書………………………………………………… i
誌謝…………………………………………………………………… ii 中文摘要……………………………………………………………… iii 英文摘要……………………………………………………………… v 論文本文……………………………………………………………… 1 Background………………………………………………………… 1 Methods…………………………………………………………… 3 Patient population………………………………………………… 3 Data collection………………………………………………… 4 Statistical analysis……………………………………………… 5 Results……………………………………………………………… 6 Characteristics of population………………………………………6 Outcomes………………………………………………………… 8 Mortality and functional outcome…………………………… 8 Length of hospitalization and medical costs………………… 11 Discussion……………………………………………………………13 Limitations………………………………………………………… 15 Conclusions………………………………………………………… 16 附錄……………………………………………………………………17 第二章 文獻探討……………………………………………………17 第一節 嚴重頭部外傷……………………………………………………… 17 第一段 頭部外傷的定義………………………………………………… 17 第二段 頭部外傷的嚴重度…………………………………………………17 第三段 頭部外傷的流行病學………………………………………………18 第二節 重度頭部外傷的預後與醫療資源耗用……………………………… 19 第一段 重度頭部外傷的死亡率與功能性預後…………………………… 19 第二段 重度頭部外傷的醫療資源耗用…………………………………… 20 第三節 對重度頭部外傷預後的推估………………………………………… 21 第一段 推估頭部外傷病患預後的研究…………………………………… 21 第二段 對重度頭部外傷病患預後推估的不確定性……………………… 23 第四節 小結…………………………………………………………………… 24 第三章 研究方法…………………………………………………… 25 第一節 研究假說………………………………………………………………25 第二節 研究對象………………………………………………………………25 第三節 資料蒐集………………………………………………………………26 第四節 統計分析………………………………………………………………26 第四章 研究結果…………………………………………………… 27 第一節 族群特徵………………………………………………………………27 第二節 死亡率和功能性預後…………………………………………………29 第三節 住院天數和醫療費用…………………………………………………31 參考文獻………………………………………………………………34 | |
| dc.language.iso | en | |
| dc.subject | 醫療花費 | zh_TW |
| dc.subject | 嚴重頭部外傷 | zh_TW |
| dc.subject | 昏迷指數 | zh_TW |
| dc.subject | 死亡率 | zh_TW |
| dc.subject | 功能性預後 | zh_TW |
| dc.subject | Traumatic brain injury | en |
| dc.subject | medical cost | en |
| dc.subject | functional outcome | en |
| dc.subject | mortality | en |
| dc.subject | GCS | en |
| dc.title | 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 | zh_TW |
| dc.title | Improvement of coma scale in severe traumatic brain injury patients after 72-hour hospital admission in relation to mortality rate, functional outcome and medical cost | en |
| dc.type | Thesis | |
| dc.date.schoolyear | 105-2 | |
| dc.description.degree | 碩士 | |
| dc.contributor.oralexamcommittee | 石崇良,郭律廷 | |
| dc.subject.keyword | 嚴重頭部外傷,昏迷指數,死亡率,功能性預後,醫療花費, | zh_TW |
| dc.subject.keyword | Traumatic brain injury,GCS,mortality,functional outcome,medical cost, | en |
| dc.relation.page | 40 | |
| dc.identifier.doi | 10.6342/NTU201701339 | |
| dc.rights.note | 有償授權 | |
| dc.date.accepted | 2017-07-10 | |
| dc.contributor.author-college | 公共衛生學院 | zh_TW |
| dc.contributor.author-dept | 健康政策與管理研究所 | zh_TW |
| 顯示於系所單位： | 健康政策與管理研究所 | |
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