Risk factors and economic impact of long-term nursing care after major trauma

Front. Public Health, 2025 · DOI: 10.3389/fpubh.2025.1535784 · Published: March 18, 2025

Simple Explanation

This study investigates the economic burden of long-term nursing care (LTC) for major trauma survivors in Taiwan, a country with universal health insurance. The research analyzes data from the National Health Insurance Research Database (NHIRD) to identify risk factors for needing LTC and to assess the associated healthcare expenditures. The findings highlight that a significant percentage of major trauma patients require LTC, leading to substantially higher healthcare costs compared to those who do not need such care.

Study Duration

10 Years

Participants

10,642 major trauma patients aged 18-70 in Taiwan

Evidence Level

Not specified

Key Findings

1
Age, comorbidities, spinal cord injury, prolonged mechanical ventilation, prolonged ICU stay, and prolonged hospital stay are independent risk factors for needing long-term nursing care (LTC).
2
The median 10-year healthcare expenditure was significantly higher in the LTC group (43,979 USD) compared to the non-LTC group (9,057 USD).
3
16.14% of major trauma patients required LTC at least 1 year after discharge.

Research Summary

This study examined risk factors and economic impacts of long-term nursing care (LTC) after major trauma in Taiwan using National Health Insurance Research Database data from 2003-2007 with a 10-year follow-up. The study found that 16.14% of major trauma patients needed LTC, with independent risk factors including age, comorbidities, spinal cord injury, prolonged mechanical ventilation, prolonged ICU length of stay, and prolonged hospital length of stay. The median 10-year healthcare expenditure was significantly higher in the LTC group (43,979 USD) compared to the non-LTC group (9,057 USD), indicating a substantial economic burden.

Practical Implications

Resource Allocation

The National Health Insurance (NHI) should consider investing more in post-discharge care for major trauma patients to improve outcomes and potentially reduce long-term costs.

Early Identification

Identifying risk factors early during hospital admission can facilitate communication with patients and families regarding discharge planning and potential long-term care needs.

Systemic Approach

A more systemic approach to post-discharge care for trauma patients is needed in Taiwan to improve their quality of life, similar to the post-acute care programs for stroke patients.

Study Limitations

1
The NHIRD lacks detailed trauma severity data such as Abbreviated Injury Score (AIS) or Injury Severity Score (ISS), limiting in-depth analysis of injury severity effects.
2
The study used the catastrophic illness certificate (CIC) as a proxy for major trauma patients, which may underestimate the exact volume of major trauma patients.
3
The healthcare expenditure analysis only included costs reimbursed by the NHI, potentially underestimating actual medical expenses as it excludes out-of-pocket payments and private insurance coverage.

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