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World J Emerg Surg. 2016 Aug 30;11(1):41. doi: 10.1186/s13017-016-0098-x. eCollection 2016.

Retrospective one-million-subject fixed-cohort survey of utilization of emergency departments due to traumatic causes in Taiwan, 2001-2010.

Yang NP#1,2,3, Phan DV#4,5, Lee YH6, Hsu JC7, Pan RH4,5, Chan CL4,5, Chang NT#6,8, Chu D2,3,9,10.

Author information

Department of Surgery & Orthopedics, Keelung Hospital, Ministry of Health & Welfare, Keelung, Taiwan.
Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan.
Department of Information Management, Yuan Ze University, Taoyuan, Taiwan.
Innovation Center for Big Data and Digital Convergence, Yuan Ze University, Taoyuan, Taiwan.
Department of Nursing, School of Nursing, College of Medicine, Chang-Gang University, Taoyuan, Taiwan.
Department of Medicine, Taipei Hospital, Ministry of Health & Welfare, Taipei, Taiwan.
School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan.
Department of Neurosurgery, Taipei City Hospital, Taipei, Taiwan.
Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.
Contributed equally



Epidemiological study was needed to evaluate trends in emergency department (ED) utilization that could be taken into account when making policy decisions regarding the delivery and distribution of medical resources.


A retrospective fixed-cohort study of emergency medical utilization from 2001 to 2010 was performed based on one-million people sampled in 2010 in Taiwan. Focusing on traumatic cases, the annual incidences in various groups split according to sex and age were calculated, and further information regarding location of trauma and type of trauma was obtained.


In 2010, significantly greater proportions of male and younger subjects were visitors to EDs with a traumatic injury. During 2001-2010, the number of both traumatic cases and non-traumatic cases presenting at EDs significantly increased (average annual percentage change, AAPC 4.7 and 3.6, respectively) and a significantly greater direct medical cost associated with traumatic cases than non-traumatic cases was noted. Focusing on traumatic cases, most of these cases were directed to highest-level hospitals, accounting for 73.5-78.8 % of all traumatic cases, with a significant AAPC of 5.6. The traumatic ED visit annual incidence in males was 58.63 in 2001, which significantly increased to 69.35 per 1000 persons in 2010 (AAPC 1.5); and in females was 38.96 in 2001, which significantly increased to 50.73 per 1000 persons in 2010 (AAPC 2.5). Most of the traumatic cases treated in EDs were minor injuries, such as contusion with the skin intact, open wound of the upper limbs, open wound of the head, neck, or trunk, and other superficial injury (accounting for about 60 % of all cases). The traumatic categories of sprains/strains of joints and adjacent muscles, fractures of upper limbs, fractures of lower limbs, and fractures of the spine/trunk required greater medical resources and significantly positive AAPC values (4.3, 4.0, 4.5 and 6.8, respectively).


Increased ED utilization due to traumatic causes, as assessed by the annual number of cases and incidence, average direct medical cost and highest-level hospital utilization, was observed from 2001 to 2010. Orthopedic-related injuries, including soft tissue trauma of extremities and various fractures, were the categories with the greatest increase in incidence.


Emergency department; Trauma; Utilization

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