第六章 結論與建議
第三節 研究限制
針對本研究不盡完善之處，提出下列限制與未來研究改善 的建議：
一、 時間記錄的取得困難
本研究乃依據外傷登錄資料庫之資料加以分析，在資料庫 中雖設有欄位，但是在急診室的病歷記載上可能有所遺漏，而 造成資料登錄上的因難。對轉診病人而言應登記由事故現場至 初診醫院的時間，初診醫院之停留時間，及轉院途中所耗用的 時間，而對直入之病人只需登錄事故現場至醫院之運送時間。
藉由推廣外傷登錄作業，加強宣導急診室醫護同仁在時間的記 錄上能更加完整，此外在轉診單上的各個時間點也應該註明清 楚。
二、 沒有全國性之資料庫
因為沒有全國性的資料庫，無法得知是否有重大創傷病人應 該要轉診至醫學中心處理，可是卻留在他院繼續處置，這類病人 的比率高低無從得知，當然也不清楚其預後。未來的相關研究可 以著重在國內的創傷救護系統建置完成之後做相關研究，比較系統完 成前後期間之不同。此外當外傷登錄更加全面化及完整時，資料庫涵 蓋的範圍更廣，可以針對區域內的各個不同等級創傷中心所收治的病 人進行分析研究，病人數目和醫院家數更多，而非局限於單一醫院。
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三、 病人轉診的原因無法得知
創傷病人轉診之原因無法進一步分析，有些病人會轉院並不 完然是醫療上的問題，原因不勝枚舉。我國民眾的就醫行為仍普 遍在有層級愈高的醫院的醫療照護愈好，無論病情是否需要，病 人及家屬的意願常影響到轉診，這樣的情況對於研究結果會造成 干擾。
四、 無法對病人做後續追蹤
對研究對象的觀察只有到出院時，出院之後的病情變化無法得 知，因此無法做後續追蹤。
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二、 中文部分
王少谷、廖訓禎、胡百敏、馬雲鵬、張玉龍、葉時烊、林作彥等：急診轉診制度 執行現況之探討－以某區域醫院及某地區醫院之經驗為例。台灣急診醫學會 醫誌 2002; 4(2): 82-90。
台灣外傷醫學會：外傷年報。2008。
行政院衛生署：健全緊急醫療救護體系五年計劃。2000。
行政院衛生署：醫療法。2009。
行政院衛生署：醫療院所辦理轉診作業須知。1987。
何世偉、葉兆斌、陳永福、周明智、陳智豪：嚴重腹部鈍傷患者合併臟器出血之 分析。台灣急診醫學會醫誌 2007; 9(3): 72-75。
陳能謹：新竹區醫療網轉診制度。2001 緊急醫療網研討會論文集刊。行政院衛 生署 2001:7-13。
財團法人醫院評鑑暨醫療品質策進會網站：醫院評鑑。
http://www.tjcha.org.tw/Identify.asp?CatID=1。
楊育純、林朝順：轉診病人急診室延遲原因分析。台灣急診醫學會醫誌 2004; 6(1):
261-268。
廖訓禎、胡百敏、廖浩欽、葉時烊、江旺財、張玉龍：台灣與美國急診轉診相關 法規之探討。台灣急診醫學會醫誌 2004; 6(2): 275-287。
蔡卓城、邱文達、謝屈平、李建興、劉永弘：急診常見之法律問題。中華民國急 救加護醫會雜誌 2002; 13(3): 93-102。
衛生署全國衛生統計資訊網：民國九十六年個人醫療費用統計結果。
http://www.doh.gov.tw/CHT2006/DM/DM2_2.aspx?now_fod_list_no=10238&
class_no=440&level_no=1
衛生署全國衛生統計資訊網：民國九十六年國人死因統計結果。
http://www.doh.gov.tw/CHT2006/DM/DM2_2.aspx?now_fod_list_no=10238&
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class_no=440&level_no=1
羅品善、游文瑜、周稚傑：兒童事故傷害嚴重性與嚴重度之評估工具。台灣家醫 誌 2005; 15(3): 159-171。
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1.4 外傷多重科別委員會(Trauma Multidisciplinary Committee) （註三） E E
1.5 須設置外傷協調員或外傷計畫經理人（註四） E E
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73 3.每年該院嚴重外傷病患(ISS≧16)之總人次與比率：
每年嚴重外傷病患總人次(ISS≧16) / 每年外傷病患住院總人次
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4.每年該院外傷病患為到院前死亡(DOA)之總人數 5.每年該院外傷病患到院後急診室死亡之總人數 6.每年該院外傷病患在院死亡之總人數與比率：
每年外傷病患住院死亡總人數 / 每年外傷病患住院總人數 7.每年該院嚴重外傷病患(ISS≧16)在院死亡總人數與比率：
每年嚴重外傷病患(ISS≧16)住院死亡總人數/ 每年嚴重外傷病
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託台灣外傷醫學會建置之外傷登錄資料庫。
(2.2)2 個月內須將 90%資料上傳至行政院衛生署國民健康局委 託台灣外傷醫學會建置之外傷登錄資料庫。
說明五：
11.1 提供高級創傷救命術(ATLS)訓練場所、設備意指：應於三年內（自 94 年 7 月 1 日起至 97 年 6 月 30 日止)至少舉辦過一次高級創
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(需於 96 年 7 月 1 日前到職者)
(1)第一級標準：百分之八十以上的護理人員每年須具備 16 小 時外傷相關繼續教育。(請附自 96 年 7 月 1 日起至 97 年 6 月 30 日止之証明)
(2)第二級標準：百分之六十以上的護理人員每年須具備 16 小時 外傷相關繼續教育。(請附自 96 年 7 月 1 日起至 97 年 6 月 30 日止之証明)
所謂：外傷相關繼續教育。
意指：急診創傷訓練課程(ETTC)、外傷護理訓練課程(TNTP)、外傷醫 學會教育委員會核發之繼續教育時數及高級創傷救命術訓練課 程(ATLS)相關訓練。
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頸椎spinous/transverse process 脫位或骨折； 線偏移<5mm；小腦挫傷<15cc 直 徑<3cm；蜘蛛網膜下出血；輕度 迫性骨折>20%；頸椎 lamina body/pedicle/facet 脫位或骨折；
頸脊柱挫傷 血<50cc <1cm 厚；腦內出 血<30cc；腦室內出血；中 軸索損傷(Diffuse axonal injury)；嚴 重咽喉破損；腦幹
78 包膜或胸導管(thoracic duct)撕裂傷；胸椎 spinous/transverse process 脫位或骨折； 折(>20%)；胸椎 lamina body/pedicle/facet 脫位或骨 折；胸脊髓挫傷伴隨短暫神經 injury)
79 spinous/transverse process 脫位或骨折；輕微腰椎壓迫 傷；腹腔動脈(celiac aretry)內 膜裂開；內、外髂骨靜脈嚴重 撕裂傷；後腹膜腔血腫；腰椎 壓迫性骨折(>20%)；腰椎 lamina body/pedicle/facet 脫位 或骨折；腰脊髓挫傷伴隨短暫 (celiac artery)輕微撕裂傷；
總髂骨或其他有命名之 (celiac artery)嚴重 撕裂傷；腰脊柱撕
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A-C joint、肩、肘、
腕、手指、髖、踝、
腔室症候群(compartment syndrome)；膝以下 壓軋傷；上臂、前臂、手指、大腿、小腿或 腳趾 degloving injury；鎖骨、肩胛骨、肱骨*、
橈骨*、尺骨*、腓骨、腕骨、掌骨、脛骨*、
跟骨、 跗骨(tarsal bone)、蹠骨(metatarsal bone)、髕骨骨折或簡單性骨盆骨折；手指或 腳趾截斷；膝扭傷；A-C joint、肩、肘、腕、
跟骨、 跗骨(tarsal bone)、蹠骨(metatarsal bone)、髕骨骨折或簡單性骨盆骨折；手指或 腳趾截斷；膝扭傷；A-C joint、肩、肘、腕、