Taipei Medical University Institutional Repository:Item 987654321/4391

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(1)台北醫學大學傷害防治學研究所碩士論文. Taipei Medical University Institute of Injury Prevention and control Master Thesis. 家庭暴力在性別差異之研究分析. Analysis of Gender Differences among Victims of Domestic Violence. 研究生:王耀慶 (Richard Yao-Chin Wang) 指導教授:蔡行瀚 (Shin-Han Tsai). 中. 華. 民. 國. 九 I. 十. 八. 年. 七. 月.

(2) 中文摘要目的：目的：本研究主要是探討家庭暴力中其性別差異間之研究分析。. 方法：方法：本文是一個兩年期回溯性世代研究，收案對象為至急診就醫且自訴為家庭暴力受害者，收案時間是從2006年01月至2007年12月，收案地點為台灣北部某醫學中心急診室。. 結果：結果：總共有866位符合收案標準的病患納入此研究(其中包含190位男性及676位女性)。女性家庭暴力受害者的年齡主要分佈在19歲至64 歲之間，與施暴者之間的關係大多數為親密伴侶 (75.5 %)；而男性家庭暴力受害者的年齡則分佈在小於18歲及大於65歲的年齡層，與施暴者之間的關係主要是直系血親 (40.0 %)。所有家庭暴力主要的施暴者為男性 (佔84.2 %)，然而在男性家庭暴力受害者中，女性施暴者卻佔了 (42.6 %)。小於18歲的年齡層在入院時昏迷指數(GCS)的部分比起其他年齡層的人，呈現中重度昏迷的比例較高(P<0.001)。在受傷嚴重度(ISS)的部分小於18歲的年齡層呈現中重度損傷的比例，比起其他年齡層的人有較高的嚴重度(P<0.001)。. II.

(3) 結論：結論：年齡是家庭暴力最重要的影響因子，而性別間的差異性同樣也會造成影響。目前男性家庭暴力受害者有逐漸增加的趨勢，尤其是18 歲以下及65歲以上的男性更是家庭暴力的高危險群。因此必須針對家庭暴力的高危險群採取主動積極的介入預防措施來降低家庭暴力的發生率。. 關鍵詞：關鍵詞：家庭暴力；家庭暴力；性別差異；性別差異；急診；急診；台灣. III.

(4) Abstract Purpose:. The aim of this study is to analyze multiple issues of. different genders in victims suffering from domestic violence.. Methods: This study is a 2- year retrospective cohort study from January 01, 2007 to December 31, 2008.. Victims who visited. emergency department of a university based medical center in Taipei city and claimed to be injured by domestic violence are enrolled into our study.. Results: Over the course of 2-year span, a total of 866 patients are enrolled in the study.. There are 190 male victims (21.9 %) and 676. female victims (78.1 %) identified during this course of study.. Majority. of female victims are localized between ages of 19 to 64 years old.. The. relationship between female victim and the perpetrator is mostly intimate partner (75.5 %). In the male victims of age groups of less than 18 years and greater than 65 years, parents and siblings account for 40% of all perpetrators.. Men are the dominant perpetrators of all domestic IV.

(5) violence (84.2 %). But in the male victims, female are responsible for 42.6 % of all perpetrators.. The age groups of less than 18 years have. more percentage of low Glasgow Coma Scale then the other three age groups (P<0.001). In case of Injury Severity Score, the age group of less than 18 years old has the highest scores of all age groups (P<0.001).. Conclusion: The most important difference between the genders in victims of domestic violence lies within the distribution of age.. There is. a steady increase of domestic violence victims every year especially male victims falling in the category of the age below 18 years of age and over 65 years of age due to the fact that most of these victims are at high risk of domestic violence.. From our study, the results show that more. active interventions and preventions should be placed on these high risk groups in order to reduce the incidents of domestic violence.. Key Words: Domestic violence, Gender differences, Emergency department, Taiwan. V.

(6) Catalog 中文摘要 ............................................................................................................................................ I ABSTRACT .........................................................................................................................................IV CATALOG ...........................................................................................................................................VI TABLE CATALOG ............................................................................................................................... VII FIGURE CATALOG............................................................................................................................... IX CHAPTER I. INTRODUCTION ............................................................................................................. 1. A.. BACKGROUND AND MOTIVATION ........................................................................................................ 1. B.. PURPOSE ....................................................................................................................................... 3. C.. DEFINITION .................................................................................................................................... 4. CHAPTER II. LITERATURE REVIEW ..................................................................................................... 6. CHAPTER III MATERIALS AND METHODS .......................................................................................... 13 A.. STUDY SUBJECT AND FRAMEWORK .................................................................................................... 13. B.. DATA COLLECTION.......................................................................................................................... 14. C.. STATISTICAL ANALYSIS ..................................................................................................................... 16. CHAPTER IV RESULTS ........................................................................................................................ 17 CHAPTER V DISCUSSIONS ................................................................................................................. 21 REFERENCE....................................................................................................................................... 28 APPENDIX-DOMESTIC VIOLENCE PREVENTION ACT ........................................................................ 102. VI.

(7) Table Catalog TABLE 1-1 家庭暴力事件通報單位次數分析 .................................................................................... 31 TABLE 1-2 家庭暴力事件通報單位次數分析 .................................................................................... 31 TABLE 1-3 GLASGOW COMA SCALE ............................................................................................................ 32 TABLE 1-4 ABBREVIATED INJURY SCALE (AIS) ............................................................................................... 33 TABLE 1-5 INJURY SEVERITY SCORE (ISS)..................................................................................................... 37 TABLE 3-1 REPORT OF DOMESTIC VIOLENCE AND CHILD PROTECTION INCIDENT (NON-SEXUAL ASSAULT INCIDENT) .. 45 TABLE 3-2 台北醫學大學市立萬芳醫院受理家庭暴力事件驗傷診斷書 ......................................... 47 TABLE 4-1 不同性別的受害者之年齡分布 ........................................................................................ 49 TABLE 4-2 不同性別的受害者之發生季節分布................................................................................. 50 TABLE 4-3 不同性別的受害者之通報時間分布................................................................................. 51 TABLE 4-4 不同性別的受害者之就醫方式分布................................................................................. 52 TABLE 4-5 不同性別的受害者之急診後動向分布............................................................................. 53 TABLE 4-6 不同性別的受害者之施暴者性別分布............................................................................. 54 TABLE 4-8 不同性別的受害者之案件類型分布................................................................................. 56 TABLE 4-9 不同性別的受害者之發生頻率分布................................................................................. 57 TABLE 4-10 不同性別的受害者之 GCS 分布 ...................................................................................... 58 TABLE 4-11 不同性別的受害者之 ISS 分數 ....................................................................................... 59 TABLE 4-12 不同性別的受害者之施暴方式分布 .............................................................................. 60 TABLE 4-13 不同性別的受害者之施暴原因分布 .............................................................................. 61 TABLE 4-14 不同性別的受害者之施暴物品分布 .............................................................................. 62 TABLE 4-15 不同性別的受害者之傷害部位分布 .............................................................................. 63 TABLE 4-16 不同年齡層的受害者之就醫方式分布........................................................................... 64 TABLE 4-17 不同年齡層的受害者之施暴者性別分布 ....................................................................... 65 TABLE 4-18 不同年齡層的受害者之加害對象分布........................................................................... 66 VII.

(8) TABLE 4-19 不同年齡層的受害者之案件類型分布........................................................................... 68 TABLE 4-20 不同年齡層的受害者之發生頻率分布........................................................................... 70 TABLE 4-21 不同年齡層的受害者之 GCS 分布 .................................................................................. 71 TABLE 4-22 不同年齡層的受害者之 ISS 分數 .................................................................................... 72 TABLE 4-23 不同年齡層的受害者之施暴方式分布........................................................................... 73 TABLE 4-24 不同年齡層的受害者之施暴原因分布........................................................................... 75 TABLE 4-25 不同年齡層的受害者之施暴物品分布........................................................................... 77 TABLE 4-26 不同年齡層的受害者之傷害部位分布........................................................................... 79 TABLE 4-27 不同年齡層及不同性別的受害者之就醫方式分布 ....................................................... 81 TABLE 4-28 不同年齡層及不同性別的受害者之施暴者性別分布 ................................................... 83 TABLE 4-29 不同年齡層及不同性別的受害者之加害對象分布 ....................................................... 85 TABLE 4-30 不同年齡層及不同性別的受害者之案件類型分布 ....................................................... 87 TABLE 4-31 不同年齡層及不同性別的受害者之發生頻率分布 ....................................................... 89 TABLE 4-32 不同年齡層及不同性別的受害者之 GCS 分數 .............................................................. 91 TABLE 4-33 不同年齡層及不同性別的受害者之 ISS 分數 ................................................................ 93 TABLE 4-34 不同年齡層及不同性別的受害者之施暴方式之分布 ................................................... 94 TABLE 4-35 不同年齡層及不同性別的受害者之施暴原因之分布 ................................................... 96 TABLE 4-36 不同年齡層及不同性別的受害者之施暴物品之分布 ................................................... 98 TABLE 4-37 不同年齡層及不同性別的受害者之傷害部位之分布 ................................................. 100. VIII.

(9) Figure Catalog FIGURE1-1 歷年家庭暴力事件通報被害人性別統計 ....................................................................... 44 FIGURE4-1 不同性別的受害者之年齡分布 ....................................................................................... 49 FIGURE4-2 不同性別的受害者之發生季節分布 ............................................................................... 50 FIGURE4-3 不同性別的受害者之通報時間分布 ............................................................................... 51 FIGURE4-4 不同性別的受害者之就醫方式分布 ............................................................................... 52 FIGURE4-5 不同性別的受害者之急診後動向分布 ........................................................................... 53 FIGURE4-6 不同性別的受害者之施暴者性別分布 ........................................................................... 54 FIGURE4-7 不同性別的受者其害施暴者分布 ................................................................................... 55 FIGURE4-8 不同性別的受害者之案件類型分布 ............................................................................... 56 FIGURE4-9 不同性別的受害者之發生頻率分布 ............................................................................... 57 FIGURE4-10 不同性別的受害者之 GCS 分布 .................................................................................... 58 FIGURE4-10 不同性別的受害者之 ISS 分數 ...................................................................................... 59 FIGURE4-12 不同性別的受害者之施暴方式分布 ............................................................................. 60 FIGURE4-13 不同性別的受害者之施暴原因分布 ............................................................................. 61 FIGURE4-14 不同性別的受害者之施暴物品分布 ............................................................................. 62 FIGURE4-15 不同性別的受害者之傷害部位分布 ............................................................................. 63 FIGURE4-16 不同年齡層的受害者之就醫方式分布 ......................................................................... 64 FIGURE4-17 不同年齡層的受害者之施暴者性別分布 ..................................................................... 65 FIGURE4-18 不同年齡層的受害者之加害對象分布 ......................................................................... 67 FIGURE4-19 不同年齡層的受害者之案件類型分布 ......................................................................... 69 FIGURE4-20 不同年齡層的受害者之發生頻率分布 ......................................................................... 70 FIGURE4-21 不同年齡層的受害者之 GCS 分布 ................................................................................ 71 FIGURE4-22 不同年齡層的受害者之 ISS 分數 .................................................................................. 72 FIGURE4-23 不同年齡層的受害者之施暴方式分布 ......................................................................... 74 IX.

(10) FIGURE4-24 不同年齡層的受害者之施暴原因分布 ......................................................................... 76 FIGURE4-25 不同年齡層的受害者之施暴物品分布 ......................................................................... 78 FIGURE4-26 不同年齡層的受害者之傷害部位分布 ......................................................................... 80 FIGURE4-27 不同年齡層及不同性別的受害者之就醫方式分布 ...................................................... 82 FIGURE4-28 不同年齡層及不同性別的受害者之施暴者性別分布.................................................. 84 FIGURE4-29 不同年齡層及不同性別的受害者之加害對象分布...................................................... 86 FIGURE4-30 不同年齡層及不同性別的受害者之案件類型分布...................................................... 88 FIGURE4-31 不同年齡層及不同性別的受害者之發生頻率分布...................................................... 90 FIGURE4-32 不同年齡層及不同性別的受害者之 GCS 分數 ............................................................. 92 FIGURE4-33 不同年齡層及不同性別的受害者之 ISS 分數 ............................................................... 93 FIGURE4-34 不同年齡層及不同性別的受害者之施暴方式之分布.................................................. 95 FIGURE4-35 不同年齡層及不同性別的受害者之施暴原因之分布.................................................. 97 FIGURE4-36 不同年齡層及不同性別的受害者之施暴物品之分布.................................................. 99 FIGURE4-37 不同年齡層及不同性別的受害者之傷害部位之分布 ................................................ 101. X.

(11) Chapter I Introduction A. Background and Motivation The Law of Control and Prevention of Sex Violation was enacted January 22, 1997 to control and prevent sex violations and domestic violence and to protect the victims' basic rights and interests. The Law of Control and Prevention of Domestic Violence was enacted June 24, 1998. According to the Ministry of the Interior, the established the Council for Control and Prevention of Sex Violation as well as the Council for Control and Prevention of Domestic Violence on May 9, 1997 and April 23, 1999, respectively, pursued the aforesaid laws. The two councils were merged on July 24, 2002 in order to coordinate joint efforts made by the judiciary laws, the police, and the governmental offices in charge of health, social welfare, education and media, and to create a system of control and prevention of sex violation and domestic violence.. The latest Domestic. Violence Prevention Act was announced on March 28, 2007. (Appendix) Although laws had been enacted, the annual numbers of domestic violence case from domestic violence and sexual assault prevention committee have increased from 43,498 to 84,195 cases during 2001 to 2008 respectively (Table 1-1 Table 1-2). From the general point of view of the public, females are the only victims of domestic violence. However, many studies have showed result to be otherwise. Not only women, but men, kids and elder ones are also 1.

(12) victims of domestic violence. every year.. More male victims are being reported. The annual numbers of male victims from domestic. violence and sexual assault prevention committee have increased from 4,441 to 16,508 during 2002 to 2008 respectively (Fig. 1-1). increment of male victims varies from 14.3 % to 55.2 %.. The. There is a. 2.9 % decrement of female victims in the year 2003. The largest increase is in the year of 2005 with 55.2% increase in male victims and 26.8% increase in female victims. Domestic. violence. cases. can. be. reported. to. various. organizations such as hospitals, police stations or any 24-hour hotline. Hospital facilities are responsible for reporting about 36% to 44% of all domestic violence cases (Table 1-1 Table 1-2).. Therefore,. emergency physicians have the greatest chance of identifying and reporting of domestic violence cases.. 2.

(13) B. Purpose The purpose of this study is to analysis different items between male and female victims suffering from domestic violence. Gaining a clear perspective of the differences can provide more information for government officials, social workers and medical personals for future studies and references.. Different services should be offered and. provided to different groups of domestic victims according to the victims’ needs and degree of physical and psychological injury. Various prevention work-ups should also be provided to the different services that offer victims from future and recurrent incidents to domestic violence.. 3.

(14) C. Definition Domestic violence Domestic violence carries different meaning and definition in different cultures and countries. In Russia, for example, the words for “battering” and “batterer” do not exist and domestic violence is referred to as “home violence”; a term not understood by all 1. In South Africa, the term “woman abuse” appears to be the preferred term used to identify domestic violence.. In Ghana, domestic. violence has been interpreted to refer to the beating of children.2 Whereas in Japan, up until recently, domestic violence typically referred to filial violence: children’s physical/emotional reactions to family members.. 3. In Japan, it could be the mother-in-law’s. treatment of the daughter-in-law or vice versa that constitutes domestic violence.3 In Taiwan, domestic violence is referred to any violent abuse and harmful behavior between family members, including partners (such as spouses, ex-spouses, cohabiters, boyfriends and girlfriends, partners of the same sex), sons, brothers, all blood relatives etc., and physical, verbal, psychological or sexual mistreatment between married couples, or economic control and financial destruction (such as tearing clothes, or destroying personal items etc.) (http://www. dspc.moi.gov.tw).. 4.

(15) Domestic violence is the selective behavior of the offender, consciously rendering the other person frightened through injury or humiliation.. Abbreviated Injury Scale (AIS) In this study, we categorize the degree of injury according to AIS (Abbreviated Injury Scale).. American Association for. Automotive Medicine classifies the regions of bodily injuries into six anatomic parts: head/neck, face, thorax, abdomen, extremities/pelvis, and external/soft tissue.. The scale ranges from 0 to 6.. The higher. the scale, the more the severity of bodily injury.4 (Table 1-4). Injury Severity Score (ISS) Injury Severity Score is calculated by the sum of square of the three highest AIS scores.. ISS ranges from 1 to 75. If any of AIS. score is 6 or out of hospital cardiac arrest, ISS will be automatically counted as 75.5 (Table 1-5). 5.

(16) Chapter II. Literature Review. Prior to 1824, a husband was legally allowed to batter his wife, provided the stick he used was smaller in diameter than his thumb, thus giving rise to the expression of “rule of thumb”.. 6. According to the. United States, Uniform Crime Reports from the Federal Bureau of Investigation in 1991, a woman is beaten every 15 seconds.7 Women are more often victims of domestic violence than victims of burglary, mugging, or other physical crimes combined.8 However, in 1992, a congressional report indicated that the most dangerous place in the United States for a woman to be is in her home.9. According to the U.S.. Department of Justice, between 1998 and 2002, out of the almost 3.5 million violent crimes committed against family members, 49% of these were crimes against spouses.10 In general, Asian women are usually hesitant to disclose battering or abuse because of their cultural views about privacy, perseverance, and self-restraint, and more difficult for battered Asian women to speak out against abuse because many cultures value family loyalty. However, little is known about the actual number of men who are abused or treated violently by women or family members. The dynamic of domestic abuse and violence is also different between men and women. The reasons, purposes and motivations are often very different between sexes.10 Although the counseling and psychological community have responded to domestic abuse and violence against women, there has been few studies that address and understand the issues of domestic abuse 6.

(17) and violence against men.11 In most cases, the actual physical damage inflicted by men is so much greater than the actual physical harm inflected by women. The impact of domestic violence is less apparent and less likely to come to the attention of others when men are abused. For example, it is assumed than a man with a bruise or black eye was in a fight with another man or was injured on the job or playing contact sports. Even when men do report domestic abuse and violence, most people are so astonished men usually end up feeling like nobody believes them. Therefore, the number of cases reported each year for men being victims of domestic abuses is much less the actual numbers in real life. 12 The UK Department of Health estimates that women on average experience 35 episodes of domestic violence before seeking help.. Many. of these women will present to emergency departments as a consequence of this abuse.13. To identify and treat domestic violence victims in an. often crowded and messy emergency room is challenging for emergency physicians due to the complexity of emergency patients. In order to rapidly identify domestic violence cases, all patients are screened by senior nurses at the triage by asking specific question regarding the reason of injury.14 registering.. Social worker will be notified while patient is. Thereafter, the emergency physician will examine the. patient in an isolated environment.. All family members and friends. should be asked to leave the premises during the examination.. As. always, the priority is to treat the physical injury and stabilize the patient. Emergency physicians are responsible to perform a thorough physical 7.

(18) examination. Injuries should be meticulously documented in the medical charts, and photographs should be taken after the consent was signed. After the medical procedures are all taking care of, social worker will follow afterwards.. The social worker will have a conversation with the. victims and fill out the domestic violence form which will fax to the domestic violence prevention center within 24 hours.. If social workers. are unavailable like in the night time or weekends, the form will be filled by emergency nurses.. It is mandatory (mandated by law) to report and. fax the form whenever domestic violence is disclosed to a physician. If the case is not reported within the time limit, a fine of 6,000 to 30,000 NTD will charged to whomever responsible. Police contact should be offered whenever there is a threat of further danger after leaving the emergency department.. Refusal of police. contact is common and may be frustrate medical staff. Common reasons include low self esteem and self blame, concerns about children, and a fear that action will lead to further violence.15 There is some evidence that abused women who involve the police have lower rates of violence then abused women who do not, though it is not clear whether this is due solely to the actions of the police. Furthermore, early identification of factors affecting the outcome of domestic violence will prevent the victim from further repeated assaults in a way which will minimize potential medical and legal burden to the society. Furthermore, early identification of factors affecting the outcome of domestic violence will prevent the victim from further repeated assaults 8.

(19) in a way which will minimize potential medico-legal burden to the society. Male and female are different in many ways.. The terms "genotype". and "phenotype" were created by Wilhelm Johannsen in 1911. Genotype is an organism's full hereditary information, even if not expressed.. Phenotype is an organism's actual observed properties, such. as morphology, development, or behavior.. From genotypic point of. view, male consist of xy chromosomes while female consist of xx chromosomes.. In phenotypic point of view, the appearances of male. and female are totally different.. For example, male have penis and. female have vagina. The hypothalamus is a portion of the brain that contains a number of small nuclei with a variety of functions. One of the most important functions of the hypothalamus is to link the nervous system to the endocrine system via the pituitary gland (hypophysis). The hypothalamus controls body temperature, hunger, thirst, fatigue, and circadian cycles. Several hypothalamic nuclei are sexually dimorphic, i.e. there are clear differences in both structure and function between males and females.. Some differences are apparent even in gross neuroanatomy.. Most notable is the sexually dimorphic nucleus within the preoptic area, which is present only in males.. Hamann 2005 used fMRI to prove that. activity of male hypothalamus is more hyperactive than female.16 Hypothalamus is the commanding center of emotion. Males are aroused by emotional stimuli which cause them to have aggressive behavior. Another organ which causes sexual dimorphism is the corpus 9.

(20) callosum.. The corpus callosum is a structure of the mammalian brain in. the longitudinal fissure that connects the left and right cerebral hemispheres.. It is better developed in female than male.. It facilitates. communication between the two hemispheres. Of much more substantial popular impact was a 1982 Science article claiming to be the first report of a reliable sex difference in human brain morphology, and arguing for relevance to cognitive gender differences.17 However, more recent studies using new techniques revealed morphological sex differences in human corpus callosum.18, 19 Females tend to have higher capability of emotional management because their corpus callusum can relate more information by both hemispheres.. Males on the other hand who use only their right. hemisphere when dealing with emotion problems, have difficult time of expression emotion. Therefore male will use force when encounter with unsolved problems while female who have better communication skill will solve problem with rationally. In adult men and women, men tend to be more dominate. Due to their poor communication skill, men will use force to settle their problem. Unlike men, women use their brain to solve their problem. hormone plays an important part.. May be the. When people reach older age, men are. weaker and women are more longevity.. Men are more easily been. victim of domestic violence. The global nature and serious impact of domestic violence is recognized by the World Health Organization (WHO) who illustrate that that not only does domestic violence have a profound effect on health, but 10.

(21) also on an individual’s self-esteem and ability to participate in the world (Krug et al. 2002).20 Low levels of education may also be an indicator of poor communication skills, which have likewise been linked to a history of domestic violence among men.21. Women with a former partner. appeared to be at greater risk for injury, and the risk increased substantially if the woman was still living with her former partner.22 In addition to being at increased risk for physical injury or death, victims of domestic violence are also at risk for complications of pregnancy and childbirth23-25; gynecologic problems; sexually transmitted disease and human immunodeficiency virus infection26-28; chronic somatic disorder 29-31. ; exacerbation of chronic medical condition; noncompliance with. medical treatment; depression, anxiety disorder, and suicide32, 33 ; eating disorder ; alcoholism34, 35 ; and substance abuse. 36. A large percentage of injured patients in this urban emergency department experienced violence in the past year. Alcohol and illicit drugs appear to be concomitant with violence.29 Emergency departments are often the first point of contact for elder neglect victims.. Elder. neglect protocols are feasible in busy emergency departments, and neglect can be accurately detected in the emergency department when screening procedures are in place.37 The study characterizes ED patients at high risk of injury from domestic violence.38. Domestic violence is an indisputable health issue for many 11.

(22) emergency department patients. The nursing care for patients in emergency and acute health care settings who have experienced domestic violence should focus on three domains of: (1) Providing physical, psychological and emotional support; (2) Enhancing safety of the patient and their family; (3) Promoting self-efficacy.39. However, because of the. high burden of suffering caused by domestic violence, health care providers should strongly consider routinely inquiring about DV as part of the history, at a minimum for all female adolescent and adult patients. 40. 12.

(23) Chapter III Materials and methods A. Study subject and framework The aim of this study is to focus on victims of domestic violence, who came to emergency department of Wanfang hospital for medical attention. A total of 15,844 patient visited emergency departments from January 01, 2007 to December 31, 2008.. There are 6,089 internal. medicine patients, 2672 pediatric patients, and 3126 others patients of specific fields like obstetrician/ gynecological patients, opthomology patient and ear/nose/throat patients…and etc.. The number of surgical. patients who first visited the trauma section is 3,957. There are 3,091 non-domestic violence related surgery patients.. Of all the surgical. patients, 866 claimed being victims of domestic violence. Once they have declared they are victims of domestic violence, social workers are then notified and report such incidence to an appropriate organization. Sexual assault victims are excluded in this study because the principal of our study is focus on domestic violence.. Second, sexual. assault and domestic violence often exhibit different traumas, different emotional and physical injuries; therefore, we exclude sexual violence in this study.. Last, victims of sexual assault are mainly examined by. obstetricians/gynecologists and or urologists, not emergency physicians. Sexual assault records are kept confidential to emergency physician. It was approved under expedited review by the institutional review board of municipal Wanfang Hospital. 13.

(24) B. Data collection Basic information on domestic violence cases is obtained from social service in Wanfang hospital. Social workers have to fill out the Report of Domestic Violence and Child Protection Incident and report to the Domestic Violence and Sexual Assault Prevention Committee via fax within 24 hours.. Report of Domestic Violence and Child Protection Incident (Table 3-1) Reporter: organization, personnel, name of organization, name, title, received time, reported time Victim:. chart number, name, sex, birth date, identification number or passport number, nationality, level of education, occupation, address, telephone number, name and telephone number of secured contact person. Offender: name, sex, birth date, identification number, nationality, address, telephone number of friends and relatives that can be contacted Facts:. time, place, description of incidence,. Relationship between the two parties: relatives. 14. Intimate partner, family,.

(25) All information from the victims are retrieved from the hospital medical records. With the medical chart, we are able to collect more data from the victims such as injury severity score and abbreviated injury score.. Emergency and hospital medical records: Name, sex, date of birth, identification number, chart number, arrival time of emergency, departure time of emergency, vital signs, physical examination, diagnosis, Glasgow Coma Scale (GCS), Injury Severity Score (ISS), Abbreviated Injury Score (AIS), outcome of event, in-hospital mortality, and length of stay in hospital. Medical Examination Certification (Table 3-2) Name, sex, birth date, identification number or passport number, occupation, address, telephone numbers, time of event, time of examination, description of injury, tools or weapons of event, result of bodily injury. 15.

(26) C. Statistical analysis Information are coded then inputted into Microsoft Office Excel 2007. We use frequency and percentage to represent the distribution. We use Student’s t-test and Chi-Square test to exam the difference the continuous variables and categorical variables.. All data are analyzed with SPSS,. version 15.0 (SPSS. Inc, Chicago, Illinois). level is set at p < 0.05.. 16. Statistical significance.

(27) Chapter IV Results Of 866 patients, female are still the majority of domestic violence victims.. There were 190 (21.9%) male victims and 676 (78 .1%) female. victims.. Demographic of domestic violence victims were divided into. male and female groups as shown in Table 4-1. In the male group, 39 (20.5%) victims are in the youngest group (less than 18 years old) and 38 (20.0%) victims are in the oldest group (older than 65 years old).. There. are 369 (51.9%) and 258 (38.2%) female victims in the younger group (19 to 40 years old) and older age group (41 to 64 years old) respectively (P < 0.001) (Table 4-1, Fig. 4-1).. Approximately 85% of female victims. came for medical attention by themselves, while only 38.9% of male victims came to the hospital either by ambulance or with family members (P < 0.001) (Table 4-4, Fig. 4-4). are male 624 (92.4%).. Most perpetrators of female victims. About half (42.6%) of perpetrators of male. victims are female (P < 0.001) (Table 4-6, Fig. 4-6).. Intimate partner. relationships occupied 75.5% and 33.1% perpetrators of female victims and male victims respectively (Table 4-7, Fig. 4-7).. Intimate partners. for female victims include husband, former husbands, estranged husbands, boyfriend or former boyfriends. Family members account for 24.5% and 66.9% of perpetrators for female and male victims respectively (P < 0.001) (Table 4-7, Fig. 4-7).. Female victims (73.9%) have higher. recidivism rate than male victims (60.9%) (P < 0.001) (Table 4-9, Fig. 4-9).. GCS and ISS are not significantly different between female and. male victims (p=0.007, P=0.046) (Table 4-10, Table 4-11). 17.

(28) Most common result of physical violence is physical assault followed by verbal violence in both genders, and the most common cause of conflict is familial conflict, about 70% in both groups. External affairs cause more conflict in the female victims (12.3%) as compared to male victims (2.6%) (P < 0.001) (Table 4-13, Fig. 4-13). common tool used in a physical struggle.. Fist is most. The use of knife is. significantly higher in male victim (9.7%) as compared to female victim (2.7%) (P < 0.001) (Table 4-14, Fig. 4-14).. The most common place of. bodily injury is the extremity, however, it plays no significant role in statistics (P=0.418) (Table 4-15). When we divide the victims into 4 age groups (<18 years, 19-40 years, 41-64 years, >65 years), the youngest and oldest group of victims came to hospital either by ambulance or with family members (P < 0.001) (Table 4-16, Fig. 4-16); perpetrators of the two middle age groups are mostly males (90.1%, 83.6%) (Table 4-17, Fig. 4-17); there are more female perpetrators in the youngest and oldest age groups (22.0%, 33.9%) (P < 0.001) (Table 4-17, Fig. 4-17); parents are the dominant perpetrators of the youngest group (80.5%) (Table 4-18, Fig. 4-18); children are responsible for 40.3% of perpetrator in the oldest group; marriage violence are responsible for 0%, 67.5%, 66.4% and 32.3% for these 4 age groups respectively (P < 0.001) (Table 4-19, Fig. 4-19); frequencies of event are not significant (p = 0.245) in all 4 groups (Table 4-20, Fig. 4-20); youngest age group have the worst GCS (P < 0.001) (Table 4-21, Fig. 4-21); the youngest age group also has the highest ISS of four groups (P < 0.001) (Table 4-22, Fig. 4-22); about half of the 2 middle age groups 18.

(29) (44.8% and 45.7%) have verbal violence (P < 0.001) (Table 4-23, Fig. 4-23); housewifery still remain the dominate cause of domestic violence in all 4 age groups but is not significant (p=0.016) (Table 4-240, Fig. 4-24); child discipline comprises a conflicting reasoning in the youngest group (28.2%) (P < 0.001) (Table 4-240, Fig. 4-24); Fist still remains the most commonly used tool in all four age groups, but is more frequently used in the two middle age groups (P < 0.001) (Table 4-25, Fig. 4-25); use of wood stick are more commonly in both youngest and oldest age groups (P < 0.001) (Table 4-25, Fig. 4-25). We further divide the victims into 4 age groups together with both genders.. The perpetrator of the female victims in the 2 middle aged. groups is predominantly males (95.4% and 94.6%) (P < 0.001) (Table 4-28, Fig. 4-28). But the perpetrators of the male victims of the 2 middle age groups are about half males and half females (P < 0.001) (Table 4-28, Fig. 4-28). Intimate partner violence accounts for 81.8% and 82.6% respectively for the perpetrators of the female victims in the 2 middle age groups (P < 0.001) (Table 4-29, Fig. 4-29).. There are significantly. more parents and brothers/sisters involved in the younger male age group (22.6% and 30.2%) (P < 0.001) (Table 4-29 Fig. 4-29). In the older male age group, there are more children and brothers/sisters involved (21.7% and 18.3%) (P < 0.001) (Table 4-29 Fig. 4-29).. Marriage. violence is responsible for about 70% and 40% for female victims and male victims of the two middle-age groups respectively (P < 0.001) (Table 4-30 Fig. 4-30).. Female victims (72.4%) have higher recidivism. rate in the younger age groups (P < 0.001) (Table 4-31 Fig. 4-31). But 19.

(30) male victims (53.8%) have higher single offenses in the younger age groups (P < 0.001) (Table 4-31 Fig. 4-31).. More knives are used as. tools in male victims (18.9%) as compared to female victims (2.6%) at younger age group (P < 0.001) (Table 4-32 Fig. 4-32).. More female. victims (81.8%) in the younger age group suffered from fist blow when compared with only 41.5% of male victims in the younger age group (P < 0.001) (Table 4-31 Fig. 4-31).. 20.

(31) Chapter V Discussions A. Gender differences From the result of our study, most of the victims are females22; however, perpetrators of domestic violence are mainly males.41. Intimate. partner violence accounts for most of the domestic violence cases in both genders.41 A previous study on Injury pattern and Risk Factor of Intimate partner violence by Lin et al.42 revealed only 7% are male victims and 93% are female victims. Both female and male victims have high recidivism rate.. Dispute, in a heterosexual relationship, is the main. cause of domestic violence for mature men and women.. Marriage. constitutes of two completely different person come from two distinct families.. Different life styles and upbringings cause couples to have. disagreements.. Thus,. much. marital. violence. are caused. by. discrepancies of opinions due to different habit or background. Beating with fists and hands tend to be the result of argument, but are all minor injuries with low AIS and ISS scores. Of all domestic violence victims, about twenty percent are males. Statistics from Domestic Violence and Sexual Assault Prevention Committee shows that the numbers of male victims are increasing on the average of 25% every year for the past 6 years (http://www. dspc.moi.gov.tw). There is an increase of male victims filing domestic violence reports as compared to previous studies. In the early 1920, agriculture played an important part of Taiwanese society.. Manpower exemplified the power of machinery, therefore 21.

(32) exhibiting the superiority of men beyond women. source of the family income. properties of men.. Man carried the sole. Women in the 1920’s were treated as. Therefore after marrying a man, all properties. belonging to the women will be owned by the man. favored men.. In the past, laws. If women got divorced, all the properties and children all. belong to the husband. In the 50’s and 60’s, women are expected from the in-laws to live with the husband’s parents and also take over the majority of the housework. Thus, this submissive behavior encourages the dominant power of men in the household. Unable to adapt to the new married life, women are often targets of physical and mental abuse of domestic violence.43 As time goes by, there was no major change. The property systems of couple had dramatic change in June 3, 1985, Properties can be registered in different name but the husband still has the power to control all the properties.. It is not until June 28, 2002, the civil law. re-enforced equality between men and women, which women gained legal control of their properties.. Now the social structure has changed,. fewer couples are living with their parents-in-law. Without the pressure from the parents-in-law, wives are more willing to express their feelings and fight for more freedom that may offend men’s pride.. As a result,. instead of the women being main target of DV, men can be victims of domestic violence as well. As the society progresses, the era of men working outside and women staying at home have interchanged. mainstream of the society.. Dual-earning couples become the. Men no longer control the power of 22.

(33) economy in the house.. There is an increasing number of female boss at. work, therefore, women no longer find themselves in a vulnerable situation in society and homes.. Men not only have to compete with. each other but also have to compete with women career wise.. Due to. the economic depression, many people are forced to take an early retirement and possible lay-off.. When men are unemployed, women. become the sole source of financial income for the family; therefore, causing the men to be emotionally distressed of financial burden.. As a. result of this new feminist movement and women being more educated, men no longer play the dominating part in families and society.. B. Age differences Age is an important risk factor for domestic violence.. Most. vulnerable victims fall in the youngest age due to the fact that they have the worst GCS and highest ISS.. Youngsters and elderly are often. defenseless when they are physically assaulted.. 40. Discipline seems to. be the most common reason of domestic violence in the youngest group. Under influence of alcohol abuse can cause devastating consequences to the victims of domestic violence. 35 As part of the Asian tradition, parents start teaching their children filial piety since the first day of birth. All parents have great ambitions and high expectations for their children. To discipline kids often means to use force, therefore resulting in beating. Traditional Asian parents feel that only through beating when disciplining, this form of actions will stay in the children’s long term memory. Therefore, children will not make the 23.

(34) same mistakes again. child abuse.. Force as a disciplinary action now evolves into. This is completely different in Europe or America.. In the. western countries, parents who discipline children with excessive force or violence will be prosecuted and may serve a sentence, depending on the country. Age plays an important factor on their behavior. different from little girl.. Little boys are. Boys are more playful which can easily upset. their caretaker either mother or father or any relatives.. On the other. hand, little girls behave better which reduce their risk of being beating by their parents or care takers. 44. Male victims under 18 years old come to the hospital most often accompanied by family or friends. It is believed that the parents come to hospital intentionally to conceal any evidence of domestic violence and to prevent children from revealing signs of domestic violence. Perpetrators of male victims under 18 years old are mostly victims’ parents.. Youngest group are physically febrile compared to adults;. therefore, they are most vulnerable in a domestic violence situation. When violence occurs, children are more severely injured than in other age groups.38, 44. C. Combination of age differences and gender differences Elderly males are sent to emergency department of our hospital by ambulances. Since males have shorter life expectancy than females, they tend to have more medical and health issues when they grow older. 24.

(35) When men are working, they have to engage lots of social activities which need to smoke cigarette and drink alcohol. So they will have heart attack and cerebral vascular accident eventually.. When they are. bed-ridden after a stroke, siblings of victims have to care daily activity. Long term care of such patient is a very tiresome labor. Therefore, elderly males are often victims of neglect.. 37. When serious medical. issues arise, they will then be sent to emergency department for medical attention.. In the male group of age 19-40 years, more perpetrators are male. As part of nature, men are more aggressive than women.. Men lacking. skill of communication become very rebellious when they encounter conflict. They are easily angered and had fight with family especially with their father and brothers.. Fist no longer can hurt their opponents. therefore they will use knife as weapon of domestic violence instead. Firearms are easily and legally possessed in the United States.. Intimate. partner homicide/suicide was most often perpetrated by middle-aged to older, married men, who used a firearm.45 ISS and AIS are higher in this group. this group.. As result of all these, the. The recidivism rate is also low in. Once they had fight with their brothers and father, men will. move out and have a new family.. Therefore less conflict happened. when they have lesser time getting together. 25.

(36) D. Limitations There are some notable limitations in this study.. First, some. unmeasured factors such as selection bias and recall bias might confound the result of our study because this is a retrospective study.. Reports of. domestic violence usually are recorded by social workers and nurses after the event had happened and victims had been examined by emergency physician.. Some victims may even report several days after the event. had happened. There is no way to tell if the victim is telling the truth or lying.. Second, our study population was relative small.. The. population of male victims is relative small compared to female victims. Smallest changes can either under- or over-estimate the result of our study.. Finally, this study was conducted in a single institution.. Several hospitals had refused to cooperate due to they have their own studies to be published. The generalization of this study result was restrained due to the complexity among various health care systems and health care providers, as well as the specific study population. But Wanfang municipal hospital is the only medical center located in southern part of Taipei city.. Even citizens from Taipei County and all. over the country came to our hospital for medical attention. validity is unquestionable.. 26. So its.

(37) Chapter VI Conclusion The result of this study shows that age difference is the most important factor affecting the different genders of domestic violence. Gender differences also have great influence in domestic violence.. Male. victims of domestic violence are increasing annually.. Young boy and. elderly man are at high risk of domestic violence.. Perpetrators are. fathers and sons of the victims.. Currently most resources have emphasis on female victims. Different help resources and prevention programs should be provided to different group of victims.. Early recognition of the difference may give. the society better understanding of the domestic violence issue. This may lead to the reduction of rate of domestic violence in bother genders. When the number of domestic violence decreases, the society will be a more harmonious environment.. Domestic violence is a serious crime that is enacted by both men and women with different socioeconomic classes, culture, and race.. The. need still exists for more future research on screening outcomes, acceptability, and effective interventions.. 27.

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(41) Table 1-1 家庭暴力事件通報單位次數分析資料日期：2001-1-1 ~ 2004-12-31. 單位：次數. 通報單位 113. 防治中心. 社政. 勞政. 教育. 警政. 司法. 衛生. 診所. 醫院. 其他. 年（月）別百分. 合計. 次數百分比次數百分比次數百分比次數百分比次數百分比次數百分比次數百分比次數百分比次數百分比次數百分比次數比 2001. 0. 0.00%. 786. 1.81%. 2826. 6.50%. 0. 0.00%. 190. 0.44% 22647 52.06%. 0. 0.00%. 35. 0.08%. 0. 0.00% 15874 36.49% 1140 2.62%. 43498. 2002. 1. 0.00%. 931. 2.08%. 1525. 3.41%. 0. 0.00%. 366. 0.82% 21361 47.78%. 0. 0.00%. 39. 0.09%. 0. 0.00% 19471 43.55% 1014 2.27%. 44708. 2003. 5. 0.01%. 651. 1.47%. 1786. 4.03%. 0. 0.00%. 374. 0.84% 22561 50.95%. 0. 0.00%. 70. 0.16%. 0. 0.00% 17353 39.19% 1480 3.34%. 44280. 2004. 3299. 6.22%. 413. 0.78%. 1866. 3.52%. 0. 0.00%. 621. 1.17% 24362 45.93%. 62. 0.12%. 66. 0.12%. 28. 0.05% 21414 40.37%. 53044. 913. 1.72%. Table 1-2 家庭暴力事件通報單位次數分析資料日期：2005-1-1 ~ 2008-12-31. 單位：次數. 通報單位 113. 防治中心. 社政. 勞政. 教育. 警政. 司法. 衛生. 診所. 醫院. 其他. 年（月）別合計. 百分次數百分比次數百分比次數百分比次數百分比次數百分比次數百分比次數百分比次數百分比. 次數百分比次數百分比次數比 2005. 7950 12.03%. 230. 0.35%. 2822 4.27%. 2. 0.00%. 1146. 1.73% 28181 42.65%. 69. 0.10%. 61. 0.09%. 51. 0.08% 24813 37.55%. 755. 1.14%. 66080. 2006. 7743 10.93%. 219. 0.31%. 2939 4.15%. 0. 0.00%. 1457. 2.06% 30522 43.08%. 92. 0.13%. 54. 0.08%. 35. 0.05% 26650 37.62% 1131. 1.60%. 70842. 2007. 9465 12.33%. 240. 0.31%. 3361 4.38%. 0. 0.00%. 1882. 2.45% 31788 41.41%. 106. 0.14%. 123. 0.16%. 25. 0.03% 28428 37.04% 1337. 1.74%. 76755. 2008. 14129 16.78%. 269. 0.32%. 3704 4.40%. 0. 0.00%. 2593. 3.08% 30940 36.75%. 127. 0.15%. 113. 0.13%. 36. 0.04% 31078 36.91% 1206. 1.43%. 84195. 31.

(42) Table 1-3 Glasgow Coma Scale item. Scale. Eye opening (E) Spontaneous. 4. To call. 3. To pain. 2. None. 1. Motor response (M) Obeys commands. 6. Localizing to pain. 5. Normal flexion. (Withdrawal). 4. Abnormalflexion. (Decorticate). 3. Extension. (Decerebrate). 2. None. (Flaccid). 1. Verbal response (V) Oriented. 5. Confused. 4. Inappropriate words. 3. Incomprehensible sounds. 2. None. 1. 32.

(43) A.I.S SCORE. Table 1-4 Abbreviated Injury Scale (AIS) 1 MINOR. Headache/dizziness 2。 to head trauma Cervical spine strain with no fracture Minor lac. external jugular V.. HEAD/NECK. PI=penetrating injury ＃Add AIS 1 with neurologic deficit not head injury related. 2 MODERATE. Amnesia from accident Lethargic/stuporous/ obstunded; can be roused by verbal stimuli Unconsciousness ＜1hr Simple vault fracture Thyroid contusion Contusion/minor lac. larynx Brachial plexus injury Cranial nerve injury Minor lac./intimal tear/thrombosis external carotid, vetebral A.＃ Minor lac. internal jugular V. Dislocation or fractuire of spinous/ transverse process of C-spine Minor compression fracture (20%) T-spine Nerve root injury. 3 SERVER NOT LIFE-THREATENING. 4 SEVERE LIFE-THREATENING. 5 SURVIVAL UNCERTAIN. Blood loss ＞20% by volume PI of skull ＜2cm deep Unconsciousness 1-6hr Unconsciousness ＜1hr with neurologic deficit Fracture base of skull Comminuted compound or depressed vault fracture Pneumoencephalus Contusion cerebrum（＜30cc;＜4 ㎝ diameter; midline shift＜5 ㎜） cerebellum （＜15cc;＜3 ㎝ diameter） Subarachnoid hemorrhage Mild brain swelling Thyroid laceration Contusion/minor lac. pharynx Perforation larynx Minor lac./intimal tear/thrombosis common＃,internal＃carotid A. Major lac. external carotid, vetebral A.＃; jugular V. Compression fracture ＞20% anterior height Dislocation/fracture lamina body, pedicle, facet of C-spine Cervical cord contusion. Unconsciousness 1-6hr with neurologic deficit Unconsciousness 6-24hr Appropriate response only to painful stimuli Fractured skull with depression ＞2cm, torn dura or brain tissue loss Contusion cerebrum （30-50cc; midline shift＞5 ㎜） cerebellum 15-30cc EDH,SDH＜50cc（＜1 ㎝ think）; ICH＜ 30cc; IVH Moderate brain swelling（Compressed ventricle） Major lac. common＃, internal＃ carotid A. Perforation pharynx Incomplete cervical cord lesion. PI of skull ＞2cm deep Unconsciousness ＞24hr Unconsciousness 6-24hr＃ Contusion cerebrum＞ 50cc; cerebellum＞30cc EDH,SDH ＞50cc; ICH ＞30cc Severe brain swelling（absence of ventricle） Diffuse axonal injury Massive destruction of larynx, pharynx Brain stem injury Cord laceration Complete cervical cord lesion C4 or below. 33.

(44) FACE THORAX. Nasal or mandibular＊fracture lac. eye, ear Superficial lac. tongue Tooth fracture/ avulsion/ dislocation. Zygoma, orbital＊fracture LeFort I, II fracture Deep laceration tongue Eyeball rupture, retinal detachment. Blood loss ＞20% by volume Optic nerve laceration LeFort III fracture. Rib fracture Thoracic spine strain Rib cage contusion Sternal contusion Bronchial contusion. 2-3 rib fractures Sternum fracture Contusion esophagus/bronchus/ diaphragm Laceration pleura/pericardium/ thoracic duct Dislocation or fractuire of spinous/ transverse process of T-spine Minor compression fracture (≦20%) T-spine Nerve root injury. Open sucking chest wound Blood loss ＞20% by volume Hemomediastinum Hemo-/pneumothorax Pneumomediastinum ＞4 rib fractures with h'/p'thorax, ＞4 rib fractures, on one side Lung contusion/laceration, unilateral$ on one side Flail chest without lung contusion ＞4 rib fractures, on each of the Tracheal, Main stem bronchus esophagus two side laceration Lung contusion/laceration, Perforation/fracture bronchus bilateral$ Diaphragm lac./rupture Flail chest with lung contusion Tracheal, Pericardium injury with temponade Main stem bronchus Myocardial minor contusion/lac. esophagus perforation Laceration esophagus/diaphragm Bronchus complete transection Intimal tear/minor lac./thrombosis Severe myocardial contusion subclavian, inominate, pulmonary A./V.; Intimal tear/minor lac./ Vena Cava thrombosis of aorta Inhalation burn, minor Major lac. subclavian,innominate, Compression fracture ＞20% anterior height pulmonary A./V.or Vena Cava Dislocation/fracture lamina body, pedicle, facet Incomplete spinal cord syndrome o f T-spine Spinal cord contusion with transient neurologic signs. $ Add AIS 1 with blood loss >20% by volume, massive air leak, systemic air emboli. 34. LeFort III fracture with blood loss ＞20% by volume. Tension p'thorax ＞4 rib fractures with hemo-/pneumothorax , on both sides Flail chest, bilateral or ＜15 y/o Tracheal, Main stem bronchus esophagus complete transection Cardiac perfpration Pericardium injury with heart herniation Major aortic laceration Spinal cord lac./ complete cord syndrome.

(45) Superficial lac. anus Major lac. perineum/scrotum/ penis/vagina/vulva/testis/ovary Contusion/superf. lac. stomach/mesentery/small bowel/ gallbladder/ ureter/urethra Contusion duodenum/bladder Minor contusion/lac. kidney/liver/spleen/pancreas Minor lac. internal, external iliac V. Dislocation or fracture of spinous/ transverse process of L-spine Minor compression fracture (≦20%) L-spine Nerve root injury. Blood loss ＞20% by volume Major laceration anus Massive complex lac. perineum Major lac. stomach/mesentery/ small bowel /gallbladder/ureter/ urethra/colon/rectum Superficial lac. duodenum/bladder Major contusion/moderate lac. kidney/liver/spleen/pancreas Minor lac. common iliac, or other named A./V. Intimal tear of celiac A. Major lac. internal, external iliac V. Retroperitoneal hematoma Compression fracture ＞20% anterior height Dislocation/fracture lamina body, pedicle, facet of L-spine Spinal cord contusion with transient neurologic signs. Massive complex lac. anus Perforation duodenum/bladder Common or hepatic bile duct transection Transection or tissue loss anus/ colon/SB/mesentery/stomach Major lac. kidney/liver/spleen/ pancreas Placental abruption Intimal tear/minor lac. abdominal aorta Minor lac. of celiac A. Major lac. common iliac or other named A./V. Incomplete spinal cord syndrome. Major lac. with tissue loss or gross contamination duodenum/rectum Complex rupture liver/ spleen/kidney/pancreas Major lac. abdominal aorta or celiac artery Spinal cord lac./ complete cord syndrome. Contusion shoulder, elbow, wrist , knee, ankle Fracture/dislocation finger, toe Sprain A-C joint, shoulder, elbow, wrist, finger, hip, ankle, toe Contusion/lac. digital, median, radial, ulnar N. Superf. lac. brachial V. Tendon injury upper extremity Min lac. brachial, other named A.. Compartment syndrome Below knee crush Degloving arm, forearm, finger, thigh, calf, toe Fracture clavicle, scapula, humerus＊, radius＊,ulna＊, fibula, carpal, metacarpal, tibia＊, calcanus, tarsal, metatarsal , patella, simple pelvic fracture Finger / toe amputation Sprain knee Dislocation shoulder, elbow, hand, A-C joint, hip, knee, ankle Muscle/tendon lac. of lower extremity; Muscle lac. of upper extremity Laceration median, radial, ulnar, femoral, tibial, peroneal N. Intimal tear/min lac. axillary, brachial, femoral, popliteal V Major lac. brachial A.. Blood loss ＞20% by volume Above knee crush Degloving hand, palm, knee, ankle, sole, foot Below knee or upper extremity amputation Comminuted pelvic fracture Fractured femur Sciatic nerve laceration Intimal tear/minor lac. femoral A. Major lac. axillary, brachial, popliteal, other named A.; axillary, brachial, popliteal, femoral, other named V. .. Traumatic above knee amputation Pelvic crush fracture with blood loss＜20% by volume Major lac. femoral A.. Pelvic crush fracture with blood loss ＞20% by volume. EXTREMITY. ABDOMEN. Contusion/ superficial lac. perineum/scrotum/penis/ vagina/vulva/testis/ovary Lumbar spine strain. ＊Add AIS 1 to these fractures if open, displaced, or comminuted. 35.

(46) EXTERNAL. Abrasions/contusions/superf. PI ＜10cm on hand/face; ＜20cm on body Avulsion＜25 cm2 on hand/ face; ＜ 100cm2on body PI with tissue loss＜25cm2 on face/extremities;＜100cm2 on body 1。burn up to 100% 2。burn 10% total body. Major lacs.＞10cm on hand/face; ＞20cm on body Avulsion ＞25 cm2 on hand/ face; ＞100cm2 on body PI with tissue loss＞25 cm2 on face/ hands;＞100 cm2 on body 2。burn 10-19% total body 3。burn ＜19% total body※. AIS=6 MAXIUMUM INJURY AUTOMATICALLY ASSIGNED I.S.S.=75 HEAD/NECK Massive destruction of both skull and brain Brain stem laceration/crush/PI Decapitation Cord crush/laceration with or without fracture C3 or above THORAX Complex myocardial laceration Chest massively crushed ABDOMEN Total separation of liver from all vascular attachment EXTERNAL 2。or 3。burn ＞90% total body. 2。or 3。burn 30-39% total body※. Blood loss ＞20% by volume 2。or 3。burn 20-29% total body※. ※ Add AIS 1 when age ＜5 years old or with face, hand, genitalia involvement. I.S.S BODY REGION. A.I.S SCORE. HEAD/NECK FACE THORAX ABO/PELVIC CONTENTS EXTREMITIES/PELVIC GIRDLE EXTERNAL I.S.S（（sum of squares of 3 most severe only））. 36. SOUARED. 2。or 3。burn 40-89% total body※.

(47) Table 1-5 Injury Severity Score (ISS) 外傷嚴重度分數（ISS）頭頸部軟組織. 頭骨. 頸椎. 腦部. 1分 2分頭皮撕裂傷頭皮撕裂傷>10cm 或 <10cm 或<100 平 >100 平方公分方公分單純頭蓋骨骨折. 頸椎損傷但無骨折或脫位. 創傷導致頭痛或二度眩暈但無意識喪失;. 頸椎 spinous/Transverse process 脫位或骨折輕度頸椎壓迫性骨折<20%. 創傷導致健忘、嗜睡、僵鈍但對聲音有反應；無意識情況<1 小時腦神經根損傷臂神經叢損傷. 3分 4分頭皮撕裂傷及超過 20%血液凹陷性顱骨骨折>2cm 流失頭顱穿刺傷<2cm 深; 顱骨基底骨折；粉碎複雜性或凹陷性顱骨骨折頸椎壓迫性骨折>20%；柱挫傷頸椎 lamina body/pedicle/ facet 脫位或骨折頸脊脊髓壓迫椎間盤突出合併神經症狀無意識 1- 6 小時；無意識情況<1 小時並伴隨神經學缺陷氣腦大腦挫傷<30cc，直徑 <4cm，或中線偏移<5mm 小腦挫傷<15cc 直徑<3cm 蜘蛛網膜下出血輕度腦水腫. 頸脊髓不完全神經損傷. 頸脊柱撕裂傷 C4 或其下的頸脊髓完全損傷. 無意識情況 1-6 小時並伴隨神經無意識情況>24 小時學缺陷；無意識情況 6-24 小時；只對疼痛刺激有反應硬腦膜撕裂或部分腦組織喪失大腦挫傷>50cc 硬膜破損或腦組織缺損小腦挫傷>30cc 硬腦膜上或下出血<50cc<1cm 厚腦內出血<30cc 腦室內出血；中度腦水腫(腦室壓迫) 小腦挫傷達 15-30cc 大腦挫傷達 30-50cc 或中線偏移 >5mm. 37. 5分頭顱穿刺傷>2cm 深. 硬腦膜上或下出血>50cc 腦內出血>30cc 嚴重腦水腫(腦室被壓迫而看不見) 廣泛性軸索損傷 Diffuse axonal injury 腦幹損傷.

(48) 外頸動脈、脊椎動脈#輕微撕總頸動脈#、內頸動脈#輕微總頸動脈#、內頸動脈#嚴重撕裂傷裂傷/內膜撕裂/栓塞；內頸靜撕裂傷/內膜裂開/栓塞；外脈輕微撕裂傷頸動脈、脊椎動脈#、頸靜脈嚴重撕裂傷其他甲狀腺挫傷;喉管輕微撕裂傷甲狀腺撕裂傷；咽部挫傷/ 咽破裂嚴重咽喉破損 /挫傷輕微撕裂傷；喉管破裂 6 分的情形: 顱骨及腦組織嚴重破壞；腦幹嚴重損傷；斷頭；C3 或其上的頸脊髓損傷註：頭頸部有 # 記號之損傷，若同時伴隨非頭部外傷導致之神經缺損，AIS 加 1 分。. 血管. 輕度之外頸靜脈撕裂傷. 1分 2分軟組織撕裂傷<10cm 或<25 平撕裂傷>10cm 或>25 平方公分方公分臉骨鼻骨、下頷骨*骨折顴骨、眼窩骨*骨折；LeFort I、 II 骨折其他部位眼睛、耳朵、表淺舌撕舌深部撕裂傷；眼球破裂；視裂傷；牙齒斷裂或脫位網膜剝離註:有 * 記號之骨折，若為開放性、移位性或粉碎性，AIS 加 1 分。. 軟組織肋骨/胸骨. 胸椎. 1分胸脊椎肌肉拉傷胸壁、胸骨挫傷一根肋骨骨折. 2分胸骨骨折二至三根肋骨骨折. 胸椎 spinous/transverse process 脫位或骨折. 臉 3分撕裂傷合併全身超過 20%血液流失 LeFort III 骨折. 4分. 5分. LeFort III 骨折合併全身超過 20%血液流失. 視神經撕裂. 胸部 3分撕裂傷合併全身超過 20%血液流失氣胸血胸氣縱隔腔一側肋骨骨折>4 根單側肺挫傷或撕裂傷$ 連枷胸無合併肺挫傷胸椎壓迫性骨折(>20%). 38. 4分開放性氣胸 (胸部有開放性吸吮性傷口) 雙側血氣胸血縱隔腔一側肋骨骨折>4 根合併血氣胸兩側肋骨骨折皆>4 根連枷胸合併肺挫傷胸脊脊髓未完全損傷症候群. 5分張力性氣胸. 兩側肋骨骨折>4 根合併血氣胸兩側連枷胸或<15 歲合併連枷胸胸脊髓撕裂傷或完全損傷症候群.

(49) 輕度胸椎壓迫性骨折 <20% 心、肺臟、食細支氣管挫傷道. 食道、支氣管挫傷肋膜、心包膜或胸導管 (thoracic duct)撕裂傷. 橫膈挫傷血管. 胸椎 lamina body/pedicle/facet 脫位或骨折胸脊髓挫傷伴隨短暫神經失能氣管、主支氣管或食道撕裂傷；支氣管、主支氣管或食道破裂；氣管破裂或斷裂支氣管全斷裂單側肺挫傷或撕裂傷$ 兩側肺挫傷或撕裂傷$ 心包膜填塞心臟輕微挫傷或撕裂傷橫隔膜撕裂或穿孔；鎖骨下、無名及肺動/靜脈，上下腔靜脈輕微撕裂傷/內膜裂開/栓塞. 嚴重心肌挫傷主動脈輕微撕裂傷/內膜裂開/ 栓塞；鎖骨下、無名或肺動/靜脈，上下腔靜脈嚴重撕裂傷. 氣管、主支氣管或食道全斷裂；；心包膜損傷合併心臟脫疝 (herniation) 心臟破裂主動脈嚴重撕裂傷. 其他部位迷走神經損傷橫隔神經損傷 6 分的情形:複雜性心肌撕裂傷；胸部嚴重壓軋傷(crush injury) 註：有 $ 記號之損傷，若合併出血超過全身 20%血量、嚴重漏氣或系統性空氣栓塞，AIS 加 1 分腹部、骨盆腔 1分 2分 3分 4分 5分軟組織撕裂傷<20cm 或<100 撕裂傷>20cm 或>100 平方公撕裂傷全身超過 20% 平方公分分血液流失血管內、外髂骨靜脈輕微撕裂傷總髂骨或其他有命名腹主動脈內膜裂開或輕微撕裂腹主動脈、腹腔動脈之動、靜脈輕微撕裂傷；腹腔動脈(celiac artery)輕微 (celiac artery)嚴重撕裂傷傷；腹腔動脈(celiac 撕裂傷；總髂骨或其他有命名 aretry)內膜裂開；內、之動、靜脈嚴重撕裂傷外髂骨靜脈嚴重撕裂傷；後腹膜腔血腫脊椎腰脊椎肌肉拉傷輕微腰椎壓迫性骨折(<20%) 腰椎壓迫性骨折腰脊髓挫傷伴隨完全神經失能 (>20%) 腰椎之 spinous/transverse 腰椎 lamina process 脫位或骨折 body/pedicle/ facet 脫位或骨折 39.