Chan H C, Aasim W A W, Abdullah N M, Naing N N, Abdullah J M, Saffari M H M, Osman A
Department of Accident and Emergency Medicine, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kota Bharu, Malaysia.
Singapore Med J. 2005 May;46(5):219-23.
Paediatric minor head injuries (MHI) are just as common in both bigger and smaller towns in Malaysia. Urban-based MHI are due more to motor vehicular injuries compared to rural-based MHI which are mainly due to non-motor vehicular injuries. The main objectives of this study were to compare incidence of admitted patients to accident and emergency departments of hospitals in two different settings in Malaysia, namely: Ipoh (urban-based) and Kota Bharu (rural-based); and to correlate to demographical characteristics, types of accident, clinical signs and symptoms, radiological and computed tomography (CT) findings, management; and finally, to determine clinical predictors of intracranial injury in MHI.
A cross-sectional study of 153 paediatric patients aged 2-18 years who were admitted to the Ipoh Hospital, Perak and 112 patients of the same age group admitted to Hospital Universiti Sains Malaysia, Kelantan were included in this study. The study period was between 1 January 1998 and 31 December 2001. Data collection was done prospectively. Chi-square and independent t-tests were applied to compare characteristics of patients admitted to these two hospitals. Backward stepwise multiple logistic regression was applied to determine clinical predictors of intracranial injury.
There were significant differences of age, race, types of accidents, clinical signs and symptoms, Glasgow coma scale (GCS), skull fracture and CT findings between two hospitals. Significant clinical predictors were headache (OR 20.8, 95 percent CI 3.9-25.2, p-value is less than 0.001), unequal pupils (OR 8.4, 95 percent CI 4.3-17.9, p-value is equal to 0.0413) and GCS score of 13 (OR =3.8, 95 percent CI 1.9-6.8, p-value is equal to 0.005). Skull fractures and intracranial injuries were more common in Kota Bharu due to children riding motorcycles without helmets than in Ipoh (p-value is less than 0.001).
In the rural Malaysian community, both the police and physicians must be alerted to the fact that unhelmeted children riding motorcycles are more likely to sustain morbidity than those in urban areas. More aggressive traffic policing of the village roads should be done by the relevant authorities.
小儿轻度头部损伤（MHI）在马来西亚的大小城镇都很常见。与主要由非机动车辆损伤导致的农村地区MHI相比，城市地区的MHI更多是由机动车辆损伤引起。本研究的主要目的是比较马来西亚两种不同环境下医院急诊科收治患者的发生率，即：怡保（城市地区）和哥打巴鲁（农村地区）；并与人口统计学特征、事故类型、临床体征和症状、放射学及计算机断层扫描（CT）结果、治疗方法相关联；最后，确定MHI中颅内损伤的临床预测因素。
本研究纳入了153名年龄在两岁至18岁之间、入住霹雳州怡保医院的儿科患者以及112名同年龄组、入住马来西亚理科大学吉兰丹医院的患者。研究时间段为1998年1月1日至2001年12月31日。数据收集为前瞻性进行。采用卡方检验和独立t检验来比较两所医院收治患者的特征。采用向后逐步多元逻辑回归来确定颅内损伤的临床预测因素。
两所医院在年龄、种族、事故类型、临床体征和症状、格拉斯哥昏迷量表（GCS）、颅骨骨折和CT结果方面存在显著差异。显著的临床预测因素为头痛（比值比20.8，95%置信区间3.9 - 25.2，p值小于0.001）、瞳孔不等大（比值比8.4，95%置信区间4.3 - 17.9，p值等于0.0413）以及GCS评分为13（比值比 =3.8，95%置信区间为1.9 - 6.8，p值等于0.005）。由于儿童骑乘摩托车时不戴头盔，颅骨骨折和颅内损伤在哥打巴鲁比在怡保更为常见（p值小于0.001）。
在马来西亚农村社区，警方和医生都必须意识到，骑乘摩托车时不戴头盔的儿童比城市地区的儿童更容易患病。相关部门应对乡村道路加强交通监管。
