臺灣博碩士論文加值系統

燒傷意外突發性的發生，除可能造成患者生命威脅及容貌毀傷與官能障礙外，所產生之醫療、心理、經濟、家庭等問題，對病人、 醫師與社會亦會造成影響。當燒傷患者住院，在早期首要目的除提高存活率外，住院日之評估也是具有重要意義的。因為住院日評估之結果對患者及其家屬壓力與負擔、臨床醫師療程上之安排規劃與醫院醫療資源管控都有相當程度之影響。
本研究採用倒傳遞類神經網路(Backpropagation Neural Network)建立燒傷患者住院日預測模型。實驗過程中將住院早期(急性期)階段分為「住院初期」與「療程初期」，住院後期階段則分為「出院準備期」，運用十摺交叉驗證法(10-fold Cross Validation)進行類神經網路網路學習。藉由分析住院早期的預測結果，以了解不同住院階段所採用之不同資料變數，對預測準確率的影響。同時亦參考住院後期之預測結果，以進一步驗證住院早期預測結果之參考價值與可行性，希望能在患者住院早期就有較佳之預測結果，藉此達到具有時效性之住院日管理機制。
實驗結果顯示，利用類神經網路建立之燒傷住院日預測模型，在住院早期階段(住院及療程初期)合理預測筆數百分比分別為50.37%及57.22%，與住院後期階段(出院準備期)之合理預測百分比62.13%相較，早期預測結果應已具有臨床之參考價值。

A burn injury is a disastrous trauma and can have very wide ranging impacts, including individual, family, and social. Burns patients generally have a long period of hospital stay whose accurate prediction can not only facilitate allocations of scarce medical resources but also help clinicians to counsel patients and relatives at an early stage of care. Besides prediction accuracy, prediction timing of length of hospital stay (LOS) for burn patients is also critical. Early prediction has profound effects on more efficient and effective medical resource allocations and better patient care and management.
Hence, the objective of this study is to apply a backpropagation neural network (BPNN) for predicting length of hospital stay (LOS) for burn patients at early stages of care. Specifically, we defined two early-prediction timing, including admission and initial treatment stages. Prediction timing at the admission stage is to predict a burn patient’s LOS when the patient is admitted into the Burns Unit. Prediction at the initial treatment stage refers to the timing right after the first surgery for burn wound excision and skin graft is performed (typically within 72 hours of injury if the patient’s condition allows). Experimentally, we evaluated the prediction accuracy of these two stages, using that achieved at the post-treatment stage (referring to the timing when all surgeries for burn wound excision and skin graft are performed) as benchmarks. The evaluation results showed that prediction LOS at the admission and the initial treatment stages could attain an accuracy of 50.37% and 57.22%, respectively. Compared to the accuracy of 62.13% achieved by the post-treatment stage, the performance reached by the initial treatment stage would consider satisfactory.

表 目 錄.............................VI
圖 目 錄...........................VIII
第一章 緒 論.................................1
第一節 研究背景 ..............................1
第二節 研究動機與目的.........................2
第三節 論文架構 ..............................4
第二章 文獻探討 ..............................5
第一節 燒傷臨床關鍵評估因素 ..................5
第二節 燒傷住院日研究相關文獻................11
第三節 類神經網路............................16
第三章 住院日預測時機及類神經模式之建立......20
第一節 預測時機 .............................20
第二節 住院日預測變數 .....................21
第三節 類神經網路建立 .....................23
第四章 實驗評估與結果 .....................26
第一節 病歷資料蒐集 .....................26
第二節 實驗步驟流程 .....................30
第三節 類神經網路參數決定 .............31
第四節 訓練驗證網路與結果分析 .............35
第五章 結 論 .............................43
第一節 研究特點與貢獻 .....................43
第二節 研究限制與未來研究方向 .............44
參考文獻 .............................46

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