Trauma Care in Taiwan- An Epidemiological Analysis of Trauma Hospitalization and Transfer
Embargo until
2015-08-01
Date
2014-05-15
Authors
Journal Title
Journal ISSN
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Publisher
Johns Hopkins University
Abstract
ABSTRACT
Background
Traumatic injuries occur frequently in Taiwan and often cause catastrophic consequences to the victims, their families and society. However, little is known about the treatment locations, hospitalization rate, interhospital transfer, and relationships among mortality, various demographics, preexisting conditions, injury severity, and socioeconomic factors at the population level in Taiwan.
Methods
Using the 2007-2008 total admission claims dataset from Taiwan’s National Health Insurance (NHI) system and a longitudinal NHI cohort dataset with a randomized population of one million, total trauma admissions and cases that involved transferring were selected for further analysis. The obtained data included patient demographics, trauma hospitalization rate, the percentage of interhospital emergency transfer (IHET) and the in-hospital mortality rate. We also aimed to analyze the factors that affect these dependent variables, such as gender, age, residency, pre-existing conditions (PECs), mechanisms of injury, associated injuries and severity.
Results
Medical centers (MC) only definitively received 25% of the injured patients, and regional hospitals (RH) admitted 45.6%. The trauma hospitalization rate found here is higher than that reported in other studies.
Males had a higher probability of being admitted to MCs, being transferred to MCs and death. Elderly patients with severe injuries had a slightly lower probability of being admitted to an MC, a lower probability of being transferred to an MC and a higher in-hospital mortality rate. Rural residents had a lower probability of being admitted to an MC, a higher probability of being transferred to an MC and a higher risk of death. After proper propensity matching for patient characteristics, being treated at MCs is not associated with a lower risk of death.
Patients who were rural residents, male, older than 64 years of age, or associated with severe anatomic injuries had a higher probability of experiencing an inter-hospital emergency transfer (IHET). However, having an IHET was not associated with a higher probability of death.
Conclusion
The inequality in accessibility to MCs and the effect of MCs on injured patients’ outcomes leave room for improvement. A policy that facilitates a regionalized trauma system to provide rural residents, the elderly and other vulnerable populations with optimal trauma care is mandatory.
Description
Keywords
Trauma, Epidemiological, Hospitalization rate, in-hopistal mortality rate, interhospital transfer