Musculoskeletal limb injury is the common injury in \ue2major trauma\ue2and also the most common cause for patients of major trauma to receive operation. The previous studies indicated that the mortality rate of this group is lower, but often combined with comorbidity in extremities. In addition, previous researches did not focus on the usage of medical resources for this kind of group.
This study uses the trauma registry database and the National Health Insurance claim data of a level I trauma center in southern Taiwan to retrospectively analyze all the cases admitted after visiting ER between January 2015 and December 2016. Within the cases which excluded the missing data, 400 matched the criteria of major trauma, and 179 of them combined with limb musculosteletal injury. At first, we compared the difference of medical resource usage between cases with and without musculoskeletal limb injury. Furthermore, relevant factors such as characters, trauma conditions and management were examined to investigate the differences in length of ventilator use, hospital length of stay, ICU length of stay and medical expenses in those who with limb injury.
The results showed that those with limb trauma received around 2 times more operations than those who without limb trauma, as their ER cost and total cost are also higher. Further analysis revealed that these major trauma patients with limb injury are primarily male averaged 47.9 years old. 80% of the mechanism is traffic accidents, and 40% of the patients were transferred from other hospitals. The most common injury site is upper limb (41.3%), as 56.4% is single site limb injury. Half of these cases were measured as AIS=2 in extremity, and 20% is open fracture. The complication rate is 6.7%, and mortality rate is 6.1 %. 80% of the patients had ever received advanced image exams, 1/3 received blood transfusion, and 80% underwent surgical intervention. The average length of ventilator use is 12.3 days, length of hospital stay is 20.1 days, and the ICU stay is 8.6 days. The average cost for whole course is NT301,001.4,inwhichemergencymedicalfeeisNT 29,747.8, and the average cost for per admission is NT$ 289,439.8. Relevant factors that influenced the length of ventilator use include gender, hospital mortality, and complications; the factors influenced hospital stays are death during hospitalization, operations and complications; factors affect ICU stay are gender, complications, and blood transfusion. Factors with influence on total cost are gender, hospital mortality, tansfusion and operations. Factors relate to hospital cost include gender, death, complications, transfusion and operations. Besides, numerous factors affect emergency fees, including age, transferred from other hospital or not, amount of limb injury, limb injury sites, open fractures, tansfusion, and advanced image study. Among all the factors, gender, hospital mortality, complications, transfusion and operation impact medical resource usage significantly.
Our research suggests that Taiwan government should set up nationwide integrated trauma registry database, and the items should include health insurance claim fee and self-pay cost which would benefit further and larger scale researches. For policy consideration, the fee for such cases of major trauma combined with musculoskeletal injury should be adjusted appropriately in order to more compatibly align the distribution of medical resource with the clinical conditions. For the clinical care, complications rate shoulde be considered as part of the quality index for trauma care so as to mitigate the unnecessary cost