背景與目的：外傷是全球公共衛生的重要議題，造成患者高度的死亡與殘疾。本研究旨在探討台灣外傷住院病人出院後一年內的死亡率及其影響因素，以期提供改善病患照護與預後的實證依據。
方法：本研究利用成大外傷登錄資料庫，分析自2013年至2021年住院且存活出院之外傷病人，並且連結死因統計檔，了解外傷病人出院之預後。研究採回朔性世代研究設計，首先利用描述性統計呈現外傷病人基本人口學特徵及臨床變項、輸血變項、外傷嚴重程度等分布情形。使用Kaplan-Meier存活曲線分析病患出院後一年的存活情形，並使用Log-rank檢定比較不同特徵病患間的存活差異。使用Cox比例風險模型進行單變量與多變量分析，以了解影響外傷病人出院後一年內死亡之危險因子。此外，欲探討不同種類危險因子之差異性使用階層式Cox迴歸分析。最後，針對年齡分組、外傷嚴重程度輕度及重度、死亡原因（外傷及非外傷）分別進行次族群分析，檢視不同族群間的危險因子差異。
結果：本研究納入共16,559名外傷病人，其中一年內死亡率為3.73%。多變量分析顯示，男性（aHR=1.66, 95% CI: 1.40-1.96）、高齡（65歲以上，aHR=10.21, 95% CI: 7.32-14.23）、跌倒機轉（aHR=3.23, 95% CI: 2.61-3.99）、慢性阻塞性肺病（aHR=3.01, 95% CI: 2.08-4.35）、糖尿病病史（aHR=1.46, 95% CI: 1.22-1.75）、腦中風病史（aHR=1.47, 95% CI: 1.12-1.92）、低GCS分數（≤8分，aHR=2.10, 95% CI: 1.49-2.96）、頭部AIS分數≥3分（aHR=2.50, 95% CI: 1.69-3.67）及接受輸血治療（aHR=1.94, 95% CI: 1.54-2.45）等因素與一年內死亡風險顯著相關。此外，次族群分析亦發現，在65歲以上患者中，跌倒（aHR=4.52, 95% CI: 3.59-5.69）、高ISS分數（aHR=3.43, 95% CI: 2.83-4.16）；在ISS分數高患者中，低GCS分數（≤8分，aHR=3.15, 95% CI: 2.47-4.02）；而在非外傷死亡患者中，慢性阻塞性肺病（aHR=4.25, 95% CI: 2.85-6.34）和糖尿病（aHR=1.75, 95% CI: 1.39-2.19）等因素均顯著增加死亡風險。
結論：外傷病人出院後一年內死亡率不容忽視，高齡、外傷嚴重度、特定臨床病史及跌倒機轉是顯著的危險因子。建議未來在外傷患者出院後進行更密切的追蹤與適當的醫療介入，以降低其長期死亡風險。

Trauma significantly impacts global public health through high mortality and disability rates. This retrospective cohort study analyzed 16,559 trauma survivors discharged from National Cheng Kung University Hospital between 2013 and 2021, using linked national death registry data to assess one-year post-discharge mortality and its risk factors. The one-year mortality rate was 3.73%. Multivariate Cox regression identified male gender (aHR=1.66), age ≥65 years (aHR=10.21), falls (aHR=3.23), COPD (aHR=3.01), diabetes (aHR=1.46), stroke history (aHR=1.47), low GCS (≤8; aHR=2.10), head AIS ≥3 (aHR=2.50), and blood transfusion (aHR=1.94) as significant risk factors. Subgroup analyses showed that elderly patients with falls and high ISS had higher mortality, and COPD and diabetes increased non-trauma-related deaths. Enhanced post-discharge monitoring and medical interventions are recommended.

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