title: Atrial fibrillation increases medical cost and complicates hospital outcome of traffic accident-related physical trauma--a nationwide population-based study.
abstract: BACKGROUND
  Traffic accidents account substantially for premature disability and deaths in the modern world. Whether atrial fibrillation complicates the outcome of traffic injury remains under-investigated.
  
  
  METHODS
  From 1998 to 2010, all inpatient records stored in the Taiwan National Health Insurance database were screened. Those related with traffic accidents were aggregated to individuals and enrolled. The medical expenses and hospital outcomes were compared between patients with atrial fibrillation (AF group) and either the rest patients (No-AF group) or the propensity-matched patients without atrial fibrillation (No-AF-matched group). Prognostic predictive variables for adverse in-hospital events were further identified by multivariate regression analysis.
  
  
  RESULTS
  Within the 13-year time span, of the 776,620 individuals ever admitted for traffic accidents, there were 1233 patients with AF. Compared with No-AF and No-AF-matched groups respectively, AF patients stayed longer in hospital (10.9 ± 10.6 vs. 6.8 ± 7.2 and vs. 8.2 ± 8.7 days, both p < 0.001), more often required surgical operations (73.2% vs. 69.5%, p = 0.006 and vs. 68.9%, p = 0.021), and consumed larger medical expenses (US$ 2384 ± 3174 vs. 1246 ± 2024, or 91.3% higher; and vs. 1406 ± 2172, or 69.6% higher, both p < 0.001), yet developed more postoperative complications (8.8% vs. 1.2% and vs. 3.2%, both p<0.001) and deaths (2.5% vs. 0.9%, p < 0.001 and vs. 1.6%, p = 0.015). Identified by regression analysis, CHA2DS2-VASC score and representative demographic/injury-related variables predict in-hospital adverse events in these AF group patients.
  
  
  CONCLUSIONS
  For patients suffering traffic accidents, those with AF consume more surgical resources and medical expenses yet end up with poorer hospital outcome, especially those with higher CHA2DS2-VASC scores and other relevant variables.
authors.affiliation: Department of Anesthesiology, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Critical Care, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan; Department of Surgery, National Yang-Ming University School of Medicine, Taipei, Taiwan.
authors.forename: Hui-Chin
authors.initials: HC
authors.lastname: Lai
authors.affiliation: Graduate School of Public Health, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Wu-Chien
authors.initials: WC
authors.lastname: Chien
authors.affiliation: Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan.
authors.forename: Chi-Hsiang
authors.initials: CH
authors.lastname: Chung
authors.affiliation: Department of Anesthesiology, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Critical Care, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan; Department of Surgery, National Yang-Ming University School of Medicine, Taipei, Taiwan.
authors.forename: Wen-Lieng
authors.initials: WL
authors.lastname: Lee
authors.affiliation: Department of Anesthesiology, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Medicine, Chung-Shan Medical University School of Medicine, Taichung, Taiwan.
authors.forename: Kuo-Yang
authors.initials: KY
authors.lastname: Wang
authors.affiliation: Taipei First Girls High School, Taiwan.
authors.forename: Chia-Ning
authors.initials: CN
authors.lastname: Liu
authors.affiliation: Department of Anesthesiology, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Critical Care, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan; Department of Surgery, National Yang-Ming University School of Medicine, Taipei, Taiwan. Electronic address: trliu@vghtc.gov.tw.
authors.forename: Tsun-Jui
authors.initials: TJ
authors.lastname: Liu
mesh_terms: D000063:Accidents, Traffic / Q000191:economics* / Q000639:trends; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000191:economics* / Q000453:epidemiology / Q000601:surgery; D005260:Female; D017048:Health Care Costs / Q000639:trends; D006760:Hospitalization / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000191:economics* / Q000453:epidemiology / Q000601:surgery; D009313:National Health Programs / Q000191:economics / Q000639:trends; D011159:Population Surveillance / Q000379:methods; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult
keywords: Atrial fibrillation; CHA2DS2-VASC; Morbidity; Mortality; Traffic accident; Trauma