台湾青少年头部损伤：城乡群体比较

Chiang Ming-Fu, Chiu Wen-Ta, Chao H Jasmine, Chen Wan-Lin, Chu Shu-Fen, Chen Shiu-Jau, Hung Ching-Chang, Tsai Shin-Han

Department of Neurosurgery, Mackay Memorial Hospital, Mackay Medicine, Management and Nursing College, Taipei, Taiwan.

Surg Neurol. 2006;66 Suppl 2:S14-9. doi: 10.1016/j.surneu.2006.08.029.

BACKGROUND

Data pertaining to head injuries in adolescents in Taiwan are scarce. The purpose of this study was to investigate the trend and pattern of head injuries in adolescents in both urban and rural areas in Taiwan.

METHODS

We collected data from major hospitals in the urban (20) and in the rural (4) areas of Taiwan for a period of 3 years. Data were obtained from the Head Injury Registry, a 10-year electronic database of head injury in Taiwan. The inpatient medical records of adolescents with head injury were thoroughly reviewed. Severity of head injury was classified by the GCS score, and patient outcome at discharge from hospital was measured by the Glasgow Outcome Scale. Differences and correlation between study groups (13-15 and 16-18 years old) in the urban and rural areas were examined using 2-tailed t and chi(2) tests.

RESULTS

A total of 469 head injury cases in the urban area and 131 in the rural area were identified. Traffic accidents were the major cause of head injury, and motorcycles were the most predominant vehicles causing traffic accidents in both urban and rural areas. Intracranial hemorrhages were the most prevalent injury pattern in the study population. In both urban and rural areas, the severities of injury were not significantly different (P=.184), but the outcomes at discharge were significantly better in urban areas (P=.032). The correlation between the initial GCS and outcomes in both areas was significant (P<.001). Craniotomy was performed more frequently in the rural area than in the urban area (15.3% vs 7.2%). The mean hospital stay was shorter in the latter than in the former (P<.001). Education on helmet use, input of neurosurgical staff, and facility and emergency medical transportation service of head-injured patients following guidelines proposed by the WFNS are crucial for head injury and better control in rural areas.

CONCLUSIONS

The causes, patterns, and outcomes of head injury were statistically different between the 2 age groups of adolescents in urban and rural areas. Further studies on adolescent head injury are necessary.

背景

台湾青少年头部受伤的数据稀少。本研究的目的是调查台湾城乡青少年头部受伤的趋势和模式。

方法

我们收集了台湾城市地区（20家）和农村地区（4家）主要医院3年期间的数据。数据来自台湾头部损伤登记处，这是一个为期10年的头部损伤电子数据库。对头部受伤青少年的住院病历进行了全面审查。头部损伤的严重程度通过格拉斯哥昏迷量表（GCS）评分进行分类，出院时的患者预后通过格拉斯哥预后量表进行衡量。使用双侧t检验和卡方检验检查城乡地区研究组（13 - 15岁和16 - 18岁）之间的差异和相关性。

结果

城市地区共确定469例头部受伤病例，农村地区131例。交通事故是头部受伤的主要原因，在城乡地区，摩托车是导致交通事故的最主要车辆。颅内出血是研究人群中最常见的损伤模式。在城乡地区，损伤严重程度无显著差异（P = 0.184），但城市地区出院时的预后明显更好（P = 0.032）。两个地区初始GCS与预后之间的相关性均显著（P < 0.001）。农村地区开颅手术的实施频率高于城市地区（15.3%对7.2%）。后者的平均住院时间比前者短（P < 0.001）。按照世界神经外科联合会（WFNS）提出的指南，开展头盔使用教育、神经外科工作人员投入以及头部受伤患者的设施和紧急医疗运输服务，对于农村地区头部损伤的预防和更好控制至关重要。