台灣地區頭部外傷描述流行病學
Descriptive Epidemiology of Head injury in Taiwan
中文摘要
從1989 年 6 月開始，臺北醫學院神經外科與中華民國神經學學會頭脊髓損傷研究小組對臺 灣地區之頭部外傷進行了階段性的研究。第一階段有關成鄉（臺北市、花連縣）頭部外傷特徵之 比較已於1992 年 7 月完成。研究發現城鄉之間存有重大之差異：發生率在臺北市為 180／
105，花連縣為 333／105。死亡率在臺北市為 38／105，花連縣為 89／105；第二階段以 臺灣東部三縣市及澎湖為研究對象，結果發現其頭部外傷之流行病特徵與花連縣相似。第三階段 為全國性之合作研究。第四階段為探討臺北市在實施機車安全帽之法規後，對頭部外傷之影響。
本報告主要為臺灣地區自1989 年 6 月至 1994 年 7 月總病例數之資料分析。病例之取得及確 認乃經由標準化的頭部外傷定義及國際疾病分類代碼（ICD-9）。並使用昏迷指數（Glasgow Coma Scale, GCS）及預後指數（Glasgow Dutcome Scale, GOS）做為評估其嚴重度及預 後之依據。
自1989 年 6 月至 1994 年 7 月五年間，共收集了 43901 例頭部外傷之病例。男性有 29831 例；女性有13696 例。最常發生之年齡層為 20-29 歲，其次為 70 歲以上。發生頭部外傷之原 因，全國皆以交通事故為主，佔70%；其次是跌落（19%），遭外力攻擊（8%）。交通事故中 以機車事故為首，佔69%；其次是行人（11%），汽車（10%），腳踏車（4%）。嚴重度以輕 度最多，佔80%；其次為重度 11%，中度佔 9%。
預後方面，死亡佔5%，植物人佔 1%，重度殘障佔 2%，輕度殘障佔 3%，良好佔 82%。共 有12024 例（28%）發生顱內血腫。探討意識喪失，顱骨骨折與顱內血腫之間的相關性時發現 是相當有意義的。顱骨骨折為硬腦膜上腔出血之相關性較其位置之出血是有意義的差別。1994 年2 月至 5 月間，臺北市實施騎乘機車戴安全帽之宣導活動後，發現頭部外傷之住院率、死亡 率及手術率均下降30%。
本研究發現，臺灣地區頭部外傷情形確比其它國家嚴重，死亡率亦高。其中更以機車事故為最嚴 重。因此，未來在制定防治政策時，應以機車問題為優先，並積極推動安全帽立法，以減少頭部 外傷之高疾病率與因之而來的社會成本及醫療資源之耗損。然後再推展到其他防治政策上。同 時，我們應積極推動國際間的合作研究，以汲取各國之經驗，做為國內推展頭部外傷防治政策之 參考。
英文摘要
A population-based study of head injury was conducted in the Taiwan area in order to understand the epidemiological features since July, 1989. The first step was completed in June, 1992. A comparison of head injury patterns between rural and urban area was performed. Taipei City was selected to represent the urban area and Hualien County as its rural counterpart. We found a significant difference between these two areas. The incidence rate was 180/100,000 in Taipei and 333/100,000 in
Hualien. and the mortality rate was 38/100,000 in Taipei and 89/100,000 in Hualien.
In step 2. two other eastern rural counties and one off-shore county of Taiwan was included through June, 1991 to July, 1993. A result similar to those of Hualien County was obtained. In step 3, a nationwide study was started since June, 1993 and is still under investigation. In step 4, the influences of helmet use enforcement program on head injury was implemented in Taipei City from February to May, 1994.
This report is focused on the data analysis of nationwide study from July 1 1989 to June 30 1994. Patient selectionand ascertainment procedures from study hospitals were through standardized definitions of head injury and associated codes in the International Classfication of Disease, 9th edition (ICD-9). Glasgow Coma Scale (GCS) and Glasgow Outcome Scale (GOS) were used in accessing the severity and outcome of head injured patients.
In this study, 43901 cases were collected, 29831 cases were male and 13696 cases were female. The incidence rates was peaked at the age of 20-29 year in both sex, followed by 70 year-old and above. An average of 70% of all head inuries were caused by traffic accidents (T.A.). Nineteen percent were due to fall and 8% by assault. Sixty nine percent of T.A. was caused by motorcycle accidents,
11%pedestrian, 10% automobile and 4% bicycles. A total of 12024 cases (28%) was found to have intracranial hematoma. The interrelationship between degree of conscious disturbance, the severity of skull fracture and intracranial hematoma were significant. The relationship of skull fracture and epidural hematoma was significant in comparing with other site of hematoma. A helmet use enforcement program was conducted in Taipei City and a 30% reduction in hospitalization, mortality and craniotomy rate were noted.
A very high proportion of head injury in Taiwan area is caused by motorcycle accidents, but very few motorcyclists are using helmet. Prevention modalities should put helmet law legislation in the first priority and the measures designed to increase the use of helmets among youngster.
