汕头市11679例颅脑创伤住院患者致伤特征及医疗费用分析

Analysis on the Characteristics and Economic Burden of 11679 Inpatients with Traumatic Brain Injury in Shantou

目的分析汕头市某三甲医院2009-2018年颅脑创伤住院患者的相关特征,明确致伤原因顺位及其医疗经济负担,为制定颅脑创伤防制措施及策略提供参考。方法采用第10版国际疾病分类标准,选取2009年1月1日至2018年12月31日入院且以颅脑创伤为病案首页主要诊断的首发病例作为研究对象,描述伤害的人群和时间等分布特征,并对住院人数及其医疗费用进行Joinpoint回归分析。结果研究的十年内,道路交通事故造成49.46%颅脑创伤患者住院,是全人群的首位致伤原因。跌倒所致的颅脑创伤造成32.20%的儿童(≤14岁)和41.79%的老年人(>60岁)入院,交通致伤紧随其后(儿童:30.59%;老年人:40.08%)。回归分析显示,交通伤、跌倒伤和坠落伤入院人数平均年度涨幅分别为4.54%、7.89%、10.75%,住院费用中位数也呈现不同幅度增长。不到两成颅脑创伤住院患者可享受基本医疗保险的医疗成本分担,超过95%的交通致伤由患者个人支付。结论道路交通事故仍是该医院辐射地区全人群颅脑创伤的首位致伤原因,儿童和老年人的颅脑创伤则主要来自跌倒。在采取有效措施遏制主要致伤类型增长的同时,也要尽快完善伤害风险分担和社会救助机制,以实现防治结合的三级预防策略。

Objective To analyze the related characteristics of inpatients with traumatic brain injury from 2009 to 2018 in a tertiary Level-A hospital in Shantou, and identify the ranking of injury causes and relevant hospitalization costs, so as to provide reference for improving injury prevention measures and strategies. Methods The 10 th edition of the international classification of diseases was adopted to include initial cases with traumatic brain injury as the main diagnosis of medical record home page from January 1, 2009 to December 31, 2018. The population and temporal distribution of the injury characteristics were described, and Joinpoint regression analysis was performed on the number of inpatients and the hospitalization costs. Results In the past decade, road traffic crashes caused 49.46% of the inpatients with traumatic brain injury, which was the leading cause of injuries among the whole population. Tumble resulted in 32.20% of the children(≤14 years old) and 41.79% of the elderly(>60 years old) being hospitalized, followed by road traffic injuries(30.59% for children, 40.08% for the elderly). The average annual increase of the inpatient numbers for road traffic crashes, tumble and falls was 4.54%, 7.89% and 10.75%, respectively. The median hospitalization costs also increased by different percentage.The hospitalized costs of less than 20 percent of inpatients with traumatic brain injury can be partly afforded by basic medical insurance, and more than 95 percent of road traffic injuries were paid by individuals. Conclusions Road traffic crashes were still the leading cause of traumatic brain injury among the whole population, while those of children and the elderly were tumbles. While effective measures should be taken to prevent the increase of dominating injury types, the risk sharing and social assistance mechanism of unintentional injury should be improved as soon as possible so as to realize threelevel prevention strategies combining prevention and treatment.