氣候、時間及地理群聚對創傷事件的影響:緊急救護資料庫研究

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題名:	氣候、時間及地理群聚對創傷事件的影響:緊急救護資料庫研究 The Effect of Weather, Time and Geographic Clustering on Trauma Event：An Emergency Medical Service Registry Study
作者:	林立偉 Lin, Li-Wei
貢獻者:	陳品玲
關鍵詞:	氣候;時間;創傷;地理空間 Weather;Temporal;Trauma;Geospatial
日期:	2013-06-17
上傳時間:	2018-10-12 10:14:56 (UTC+8)
摘要:	背景：研究者自急診照護經驗中發現在特定天氣狀況及特定時段會突然湧入大量外傷病患，造成急診室的工作壓力增加。一般相信高溫、下雪、週末及傍晚會增加創傷入院的人數。不同的氣候型態會發生不同的創傷事故，如嚴熱的氣候會增加創傷入院人數，特別是因為戶外活動增加所致。另外一般也相信下雨會有較多的汽車交通事故發生。目的：評估緊急救護系統創傷病患多寡是否會受到氣候和時間因素的影響，並探討重大創傷與氣候及時間因素的關係。分析重大創傷事件的地理空間分佈，並且了解降雨是否會造成重大交通事故及跌倒傷害事件地理空間分佈的不同。方法：本研究採次級資料庫分析之研究設計。由台北市消防局取得 2009年1月1日至2010年12月31日到院前緊急救護資料，並自中央氣象局申請台北市相同時間的氣象資料。利用零膨脹卜瓦松查廻歸(zero inflated Poisson regression)分析每小時創傷人數跟氣候及時間因素的關係。利用多變項邏輯迴歸(Multivariate logistic regression)分析氣候和時間因素對重大創傷事件和非重大創傷事件的影響。將重大創傷事件的發生地點轉換成全球定位系統座標，利用空間統計軟體標定地理空間群聚的區域，並分析降雨是否會造成重大交通事故及跌倒創傷事件的地理空間群聚效應。結果：在研究期間，台北市消防局救護隊總共出勤68,927人次。不同類型的傷害和氣候及時間因素各自有不同的相關性。氣溫每上升一度則每小時總創傷人數(IRR=1.0050)、交通事故傷害人數(IRR=1.0075)、機車事故傷害人數(IRR=1.0085)及其他類型傷害人數(IRR=1.0109)增加。降雨時不管小、中、大雨，增加每小時總創傷人數(IRR分別為1.0629、1.0897、1.1055)及跌倒傷害人數(IRR分別為1.0733、1.2053、1.3209)。但是交通事故傷害及機車事故傷害僅與小雨相關(IRR分別1.1105及1.0607)，而其他類型傷害僅於中雨相關(IRR=1.1779)。有完整1小時日照時，每小時總創傷人數(IRR=1.1541)、交通事故傷害人數(IRR=1.2002)、機車事故傷害人數(IRR=1.1877)及跌倒傷害人數(IRR=1.1316)增加。每天總創傷人數(IRR分別為3.1453及3.2518)、交通事故傷害(IRR分別為5.0284及5.0668)及機車事故傷害人數(IRR分別為5.8142及5.5141)於7am至11am及3pm至7pm呈現雙高峰分佈。跌倒傷害(IRR分別為2.3322及2.4779)及其他類型傷害(IRR分別為1.5923及1.6695)則在3pm至7pm及7pm至11pm間呈現高峰。一星期中總創傷、交通事故及機車事故傷害人數高峰出現在星期一至星期五，星期六人數下降，最低出現在星期天。假日和星期天並無差別，但連續假日時病患人數持續下降(IRR相對於星期天分別為 0.9056、0.8819、0.8818)。跌倒傷害僅在星期一時有增加(IRR=1.0895), 而連續假日時病患人數則是減少(IRR=0.8954)。其他類型傷害星期一至星期五呈現下降，假日及連續假日則呈現上升(IRR分別為1.1920及1.1277)。一年中總創傷、交通事故及機車事故傷害人數高峰出在十二月，低點位於二月。跌倒傷害則是十月至一月間呈現高峰，而其他類型傷害高峰出現在十二月。重大創傷在氣候因素方面僅機車事故傷害於白天較不易發生(OR=0.649)，其他類型傷害反而白天較易發生(OR=1.423)。其他氣候因素並不會影響重大創傷的發生。各類不同重大創傷事件有不同的地理空間的群聚分佈，但重大交通事故及跌倒創傷並不會因降雨而產生地理空間分佈的不同。結論：氣候和時間因素會影響緊急救護系統創傷病患的人數。光線的狀況和時間會影響重大創傷發生。重大創傷的發生有地理空間的群聚現象，但不會因降雨與否而改變重大交通事故及跌倒創傷地理空間的分佈。根據研究的結果，可以協助緊急救護系統規劃救護的準備及進行事故傷害的預防。 Background: The numbers of trauma patients visited to an ED increased during specific weather condition and time had been noted. It is widely believed higher temperatures, rain, weekends and evenings increase trauma admissions. Different weathers and temporal factors have different effect on different trauma. For example, hot weather is associated with trauma admission because of increase outdoor activities. Rainy days are also associated with more numbers of road traffic accidents. Objective：The purposes of the study are to determine the association between weather-temporal factors and emergency medicine system (EMS) trauma attendance, weather-temporal risks factors of major traumatic events, geospatial clustering of major traumatic events and the effect of precipitation on the geospatial distribution of major traffic accident related injuries and fall related injuries. Methods： EMS trauma data from the fire department of Taipei city from Jan 1, 2009 to Dec 31, 2010 was obtained and linked with local weather data from the Central Weather Bureau. Hourly numbers of trauma patients were analyzed by zero-inflated Poisson model. The weather-temporal risks for major trauma were determined using by multivariate logistic regression. Geospatial clustering of major traumatic events were identified by SaTScan software and clustering of major traumatic traffic accident injuries and fall injures by influencing of precipitation were also analyzed. Results： There were 68,927 patients in this study. Different type of trauma had different weather and temporal relationships. Higher temperatures (every 1˚C) increased hourly numbers of total trauma (IRR=1.0050), traffic accident (IRR=1.0075), motorcycle accident related injuries (IRR=1.0085) and other trauma (IRR=1.0109).During rainy hours mild, moderate and heavy rain increased the numbers of total trauma (IRR=1.0629 v.s.1.0897 v.s.1.1055) and fall (IRR=1.0733 v.s. 1.2053 v.s. 1.3209).But traffic accident and motorcycle accident related injuries were only related to light rain (IRR=1.1105 v.s.1.0607) and other trauma was associated to moderate rain (IRR=1.1779). Sunshine increased the hourly numbers of total trauma (IRR=1.1541), traffic accident (IRR=1.2002), motorcycle accident related injuries (IRR=1.1877) and fall (IRR=1.1316). 7am to 11am and 3pm to 7pm were two peaks in a day for total trauma (IRR=3.1453 v.s. 3.2518), traffic accident (IRR=5.0284 v.s.5.0668) and motorcycle accident related injuries (IRR=5.8142 v.s.及5.5141). Fall (IRR=2.3322 v.s. 2.4779) and other trauma (IRR=1.5923 v.s.1.6695) had peak at 3pmto 7pm and 7pm to 11pm.Total trauma, traffic accident and motorcycle accident related injuries had peak between Monday to Friday, decrease on Saturday, had trough on Sunday. Compare with Sunday, the numbers of patients declined (IRR=0.9056 v.s 0.8819 v.s. 0.8818) during long holidays. Fall only increased on Monday (IRR=1.0895) but decrease in long holidays (IRR=0.8954). The numbers of other trauma decreased between Monday to Friday, but increase on holidays and long holidays (IRR=1.1920 v.s. 1.1277). The numbers of total trauma, traffic accident and motorcycle accident related injuries had peak in December, and were lowest in February. Fall had peak between October to January and other trauma had peak in December. Only daylight condition was the risk for major traumatic events. Daylight decreased the numbers of major motorcycle accident related injuries (OR=0.649) but increased major other trauma (OR=1.423). Other weather variables were not associated with major trauma. Major traumatic events demonstrated geographic clustering and different types of major traumatic event showed different distribution of geographic clustering. But precipitation did not influenced the location of major traffic related and fall injuries. Conclusions： Weather and temporal variations affect hourly numbers of EMS trauma patients. Only light condition and temporal factors were the risks for major traumatic events. There were geospatial clustering of major traumatic events. But precipitation did not influence the distribution of major traffic related injuries and fall injuries. Data from this study could be useful for EMS preparation and injury prevention.
描述:	碩士指導教授-陳品玲委員-王宗倫委員-廖勇柏
資料類型:	thesis
顯示於類別:	[傷害防治學研究所] 碩博士論文

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