第五章 討論
第二節 建議
在本研究雖然 GCS miss 只有 396 筆資料，GCS 的紀錄率高達 99％比一般紀錄率高12，但還是沒有達到百分之百。因此應該在病 歷上明顯的標示睜眼反應、運動反應、語言反應及 GCS 項目，以方 便醫生例行性紀錄，提高相關研究的可靠性。
對於緊急醫療體系而言，GCS 是一個可以協助分類及治療判斷 的簡單工具 13。但救護人員無法在送達醫院前確實評估外傷性腦受 傷患者之 GCS14。而隨著時間點不同評估出來的 GCS 也有所不同，
因此可以對於救護人員進行 GCS 評估訓練，以獲得送達醫院前之 GCS，減少送醫時間而產生 GCS 評估之誤差。
睜眼反應＋運動反應評估死亡之準確性與 GCS 評估死亡之準 確性差異不大，因此對於因酒醉或服用藥物而受傷，或是在送達醫 院時已進行插管的急救病患，導致語言反應無法判斷造成 GCS 無法 計算，將可以改用睜眼反應＋運動反應分數進行評估。
雖然 GCS 分數相同，但隨著睜眼反應、運動反應、語言反應分 數的不同，所造成的存活情形也會有差異。因此在評估受傷嚴重度
調整其他變項後，睜眼反應、運動反應、語言反應、GCS 分數 對於死亡相對危險性之預測能更為清晰及更有檢定能力。因此在以 睜眼反應、運動反應、語言反應、GCS 分數進行死亡相對危險性之 預測時，應該將人口學特性一起併入預測因子中。
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頭部外傷調查表
Ⅰ.基本資料： （請盡量避免填寫”不詳”的答案）
1.姓名：_________________ 2.性別：c□男性 d□女性 3.出生年月日：____ 年____ 月____ 日 4.身份證字號：□□□□□□□□□□ 病歷號碼：□□□□□□□□□□
5.戶籍所在地：c□台北市 d□花蓮縣（市） e□其他地區（請註明地區 _______________）
6.工作地點：c□台北市 d□花蓮縣（市） e□其他地區（請註明地區 _________________）
7.聯絡地址：
8.電話：（____）_______________ 9.職業：_________ 職位：___________
10.保險種類：b□健保 c□勞保 d□公（眷）保 e□農保 f□軍（眷）保 g□榮保 h□學生平安保險 i□其他保險 j□無 k□不詳
Ⅱ.受傷資料：
11.受傷時間：________年________月________日下午_______時
12 受傷後第一次送至醫院治療之時間：________年________月________日下午______時
13.送醫之方式：c□救護車 d□小客車 e□機車 f□步行g□不詳 h□其他 ________________ h□不詳 i□其他 ________________
(5)□墜落物襲擊 i□不詳 j□其他 ________________
26.車禍發生時之道路位置：c□快車道 d□慢車道 e□路肩 f□路邊 g□行人穿越道 h□交叉路 i□安全島 j□不詳 k□其他 _________________
27.車禍發生時之路況：c□平直柏油或水泥路 d□陡坡 e□急彎 f□路面坑陷 g□砂石路面 h□整修施工中 上
上
問卷一
M：________________
V：________________
TOTAL：___________
32.有無喪失意志：c□有 d□無 e□不詳
c□脊椎骨折，是屬(可複選)： a.□頸椎 b.□胸椎 c.□腰薦椎，位置（第幾個）________________
d□顏面骨折 44.有否病理解剖：c□有，其結果為______________________________ d□無 e□不詳
45.傷者住院之時間：__________年__________月_________日；住加護病房：c□有，共__________天 d□無 e□不詳 傷者出院之時間：__________年__________月_________日；住普通病房：c□有，共__________天 d□無 e□不詳 f□其他 _____________
傷者死亡之時間：__________年__________月_________日
傷者死亡之原因(可複選)：c□直接死於腦受傷 d□死於外傷合併症 e□死於內科疾病 f□不詳 g□其他 ___________