臺灣博碩士論文加值系統

背景：過去多數研究皆指出，有過跌墜經驗的傷患，會增加其再發生跌墜的風險。重複跌墜的發生，除了造成生命年數和生產力損失外，也會增加醫療利用的需求並造成家庭和社會龐大的經濟負擔。
目的：瞭解臺灣單次跌墜與重複跌墜傷患流行病學特性，並找出傷患發生重複跌墜之預測因子。
方法：本研究屬追蹤研究，使用全民健保2005年百萬抽樣歸人檔(LHID2005)，選取E-code碼880-888（意外跌墜）為研究對象，瞭解單次跌墜與重複跌墜者兩組傷患在追蹤期間發生重複跌墜住院情形。
結果：研究期間共有12,632跌墜個案，其中重複跌墜者有1,232人（佔0.1%）。跌墜傷患在1年內重複跌墜發生率為每百人2.28，其重複跌墜發生率的高危險群為65歲以上老人（每百人12.75）及女性（每百人10.64）。重複跌墜者為女性（59.2% vs. 55.6%）、65歲以上（66.2% vs. 49.9%）、低收入戶者（3.0% vs. 1.9%）、重大傷病身分（10.1% vs. 5.4%）、跌墜史（31.2% vs. 0.6%）及查爾森合併症指數大於1分以上者（42.5% vs. 28.8%）的比例高於單次跌墜；重複跌墜者就醫季節為夏季（27.5% vs. 24.6%）與冬季（26.0% vs. 25.5%）、就醫地區為中區（35.4% vs. 32.6%）與南區（33.2% vs. 30.3%）及都市化程度為一般鄉鎮市區（21.6% vs. 17.8%）與高齡農業偏遠地區（3.5% vs. 3.1%）的比例高於單次跌墜者；重複跌墜害為頭部外傷的比例（17.9% vs. 14.9%）及平均傷害數目（2.37個 vs. 1.87個）皆高於單次跌墜者。在醫療利用情形，重複跌墜者於區域醫院就醫（55.2% vs. 52.6%）、有接受處置者（32.0% vs. 27.6%）、平均住院天數（10.22天 vs. 7.5天）及平均醫療費用（61470元 vs. 51213元）的比例均比單次跌墜高。女性、25-44歲及65歲以上者、重大傷害、跌墜史、查爾森合併症指數及傷害數目同時是重複跌倒與重複墜落的預測因子，而45-64歲、冬季、中度都市化市鎮、新興市鎮及骨折為重複跌倒的預測因子，高農偏離市鎮為重複墜落的預測因子。
結論：跌墜史為預測重複跌墜的重要因子。未來相關單位須針對高危險群進行合適的防制計畫外，還需加強25-44歲者職場安全，以降低職業傷害發生。此外，相關單位及醫療院所亦須針對跌墜住院死亡的危險因子，研擬對應之道，以改善傷患之預後情形。

Previous studies showed patients who had history of falls were at a greater risk of falling again. Recurrent falls would lead to injury, disability, death, days of potential work lost of patients, which affect the development of the country and increase the medical utilization. The objectives of this study were to describe and compare the epidemiological characteristics between single falls and recurrent falls in the hospital in Taiwan and to find the predictors of recurrent falls.
This study was a retrospective cohort study. We analyzed data on “inpatient expenditures by admission” and “registry for contracted medical facilities” in National Health Insurance-Longitudinal Health Insurance Database (NHI LHID) from 2006 to 2010. We defined falls cases as ICD-9-CM E880-E888.
Results showed that there were 12,632 cases during study period and 1,232 individuals (10%) were recurrent falls. The incidences of recurrence were 2.28 person-years in total population, 10.64 person-years in females and 12.75 person-years in people aged 65 years and older. Females and elders had greater risks in recurrent falls. Recurrent falls were more likely to develop in low-income households (3.0% vs. 1.9%), severe illness (10.1% vs. 5.4%), history of previous falls (31.2% vs. 0.6%), Charlson Comorbidity Index’s score more than one point (42.5% vs. 28.8%).
Recurrent falls were more likely to develop in hospital in summer (27.5% vs. 24.6%), winter (26.0% vs. 25.5%), general township (21.6% vs. 17.8%) and the town with older, agricultural and rural (3.5% vs. 3.1%). Recurrent falls were also more likely to cause traumatic brain injuries (17.9% vs. 14.9%), visits in regional hospitals (55.2% vs. 52.6%) longer hospital stay (10.22 days vs. 7.5 days), and higher average medical expenditures (NTD 61470 vs. NTD 51213).
The predictors of recurrent falls were females, aged 25-44 years, elders, severe illness, history of previous falls and high Charlson Comorbidity Index. Moreover, the predictors of recurrent falls from the same level were aged 45-64 years, winter, moderate urbanization town and fractures. The predictors of recurrent falls from one level to another were the town with older, agricultural and rural.
This study highlights several indicators of recurrent falls observable during medical visits. The predictors of recurrent falls were females, aged 25-44 years, older age, severe illness, history of falls and high Charlson Comorbidity Index. We should make prevention programs on high-risk groups, and pay attention to patients with aged 25-44 years for occupational safety and health.

致謝 I
目錄 III
表目錄 V
圖目錄 VII
附錄目錄 VIII
摘要 IX
Abstract XI
第壹章　緒論 1
第一節、研究背景 1
第二節、研究動機及重要性 4
第三節、研究目的 6
第貳章　文獻探討 7
第一節、名詞定義 7
第二節、重複跌墜族群發生率與盛行率之現況 10
第三節、重複跌墜族群之流行病學特性及危險因子 15
第四節、單次跌墜與重複跌墜族群特性比較 34
第參章　研究方法 38
第一節、研究架構 38
第二節、研究假設 41
第三節、研究材料 42
第四節、名詞解釋 45
第五節、研究變項與操作型定義 47
第六節、資料處理與統計分析 52
第肆章　研究結果 55
第一節、流行病學特性 55
第二節、重複跌墜者之跌墜方式 80
第三節、重複跌墜傷患之預測因子 85
第四節、跌墜住院死亡風險因子 93
第五節、重複跌墜傷患發生率 97
第伍章　討論 102
第一節、單次與重複跌墜傷患流病特性 102
第二節、重複跌墜者之預測因子 108
第三節、跌墜住院死亡之危險因子 114
第四節、重複跌墜發生率 117
第五節、研究限制 119
第陸章　總結 120
第一節、結論 120
第二節、建議 123
參考文獻 129

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