急診急性肝炎病患醫療資源耗用相關因素之研究

Abstract

台灣Ｂ型肝炎帶原人數約三百零六萬人；而Ｃ型肝炎感染人數約四十二萬人，肝炎是台灣的國病, 國內外對於肝炎病患中的肝硬化及肝癌的預後預測研究不少, 但對於急性肝炎病患醫療資源耗用的預測研究卻不多。 目的：探討急診急性肝炎病患之病人特質及臨床特質與醫療資源耗用之相關性。 方法：以醫院資訊系統與病歷審閱收集研究資料進行回溯性研究，選取自2003年一月份至2007年六月份至台北市某家規模1000床教學醫急診就診的急性肝炎病患成為研究對象，分析病患特質(包含性別及年齡層)及病患的臨床特質(肝炎種類、Child-Pugh Score以及腹部超音波檢查結果)與醫療資源耗用(包含住院天數以及醫療費用)的相關性。 結果：研究期間該醫院急診共有急性肝炎發作病患124人就診，其中資料完整共117人次。經ANOVA分析，病患特質(包含性別及年齡層)、肝炎種類均和醫療資源耗用(包含住院天數以及醫療費用)沒有顯著的相關性。但是病患的臨床特質中，Child-Pugh Score與醫療資源耗用(包含住院天期以及醫療費用)有顯著相關性；腹部超音波檢查中脾臟腫大此一項目和住院天數有顯著相關係，而腹部超音波檢查中腹水此一項目和醫療費用中總申報點數有顯著相關性。 結論：Child-Pugh Score傳統上用來預測肝硬化及末期肝病病患的預後，而腹部超音波亦是常用來快速診斷及評估急性肝炎的工具，本篇研究發現Child-Pugh score和腹部超音波可以共同用來預測急診急性肝炎病患(排除肝硬化患者)的醫療資源耗用。

Taiwan is a hyperendemic area of Hepatitis B virus (HBV). The estimated total number of HBsAg carriers in the general population > 20 years old is 3,067,307 and 61% patients involved in this study are hepatitis B related. A case record review was conducted from January 2003 to June 2007 of all patients admitted to the Emergency Department (ED) of one university hospital with diagnosis of acute hepatitis. The prognosis of liver cirrhosis is assessed by using Child-Pugh score. Since abdominal ultrasound is also a commonly used tool for the evaluation and rapid diagnosis of acute hepatitis in the ED, the objective of this study is to determine whether Child-Pugh score and abdominal ultrasound could be used simultaneously to predict the medical resource utilization in patients of acute hepatitis without liver cirrhosis in the ED. The characters, such as sex, age and type of hepatitis, of the patients were also analyzed. The medical resource utilization is defined as the length of hospital stay and the total medical fee. The statistic procedure, Analysis of variance (ANOVA), was adopted in the data analysis. A total of 117 patients met the inclusion criteria. The characters of the patients, such as sex, age and the type of hepatitis, have no significant differences of medical resource utilization. However, Child-Pugh score has significant differences of medical resource utilization on both the length of hospital stay and the total medical fee. Besides, the finding of abdominal ultrasound such as splenomegaly has significant difference on the length of hospital stay, and the finding of abdominal echo such as ascites has significant difference on the total medical fee. In conclusion, Child-Pugh score and abdominal ultrasound could be used simultaneously to predict the medical resource utilization in patients of acute hepatitis without liver cirrhosis in the ED.