A 10-Year Study of Traumatic Brain Injury in Adolescent in Taiwan

青少年頭部外傷之趨勢研究

 近四十年事故傷害來一直高居國人十大死因的前五位，且成為台灣地區 10~19 歲青少年的第一大死 因，佔該年齡層死亡原因的百分之五十以上，其中 15~19 歲更高達 71.84 ％的比率 1 。另根據衛生 署統計資料，青少年常見的事故傷害死因中，最主要的原因為運輸事故，約佔所有事故傷害死因的 50 ％，其中受傷部位又以頭部為最多。為進一步了解青少年頭部外傷之趨勢與影響，本研究收集 台北、花蓮兩區青少年頭部外傷資料，以台北市 20 家及花蓮 4 家醫院，自民國 84 年 1 月 1 日至 93 年 12 月 31 日的青少年（ 10-19 歲）頭部外傷病患，共計 4999 人。以回溯性方式收集十年間病歷 資料之趨勢變化，並比較城鄉之發生原因、嚴重度及預後情況等。台北地區 84-93 年間青少年平均 頭部外傷發生率為 100/ 每十萬人口，花蓮地區約為 151/ 每十萬人口；平均死亡率在台北地區約為 6.6/ 每十萬人口，花蓮地區約為 7.3/ 每十萬人口。針對每一個年齡層進一步分析受傷的原因、徵候 及預後情形等。結果發現 10-19 歲頭部外傷的患者中男性佔大多數（ 67.8% ），男女比約為 2:1 。 比較城鄉地區 10-19 各年齡層的發生率， 10-14 歲年齡層以跌落最高， 15-19 歲年齡層則以車禍居 多，整體而言，青少年頭部外傷的發生率隨著年齡增加而上升，且以 17-19 歲最高。以受傷原因來 看，城鄉皆以車禍最多，其次是跌落、遭人攻擊。以受傷情形而言，有顱骨骨折佔 13.5 % ；有意 識喪失者佔 31% ；有傷後健忘者佔 11.6 % ；傷後有痙攣者佔 1.8 % ；有顱內出血者佔 25.2 % 。在 探討 84-93 年間發生率的趨勢時，發現頭部外傷在這 10 年間的趨勢中，於 87 到 90 年呈現穩定的 下降，但於 90 年開始卻又開始攀高，值得高度關注。究其原因，影響的因素甚多，且部分可能與 86 年開始執行安全帽立法有關，但於 90 年後沒有繼續嚴格執行而故態復燃。由本文可見，目前青 少年頭部外傷的發生率仍居高不下，其所導致的死亡、殘障及對社會經濟的衝擊較其他年齡層的影 響更鉅。因此，未來建議加強青少年事故傷害的防治，其中， 15-19 歲希望由交通事故的防治介入 為主軸，而 10-14 歲則以跌落的介入為未來的方向。

A 10-Year Study of Traumatic Brain Injury in Adolescent in Taiwan



In the past 40 years, accidents were always the first five leading cause of death in Taiwan. It was the first leading cause of dea

th for adolescent aged between 10 and 19 in Taiwan, which caused more than 50% of deaths in that age group; among them, t

he subgroup for ages between 15 and 19 even reached 71.84% for deaths caused by accidents1. According to statistical inform

ation from the Department of Health, traffic accidents were the major cause of injury death commonly seen among adolescent,

which caused 50% of the accidental deaths and most of them got head injuries. In order to get a further understanding on the tr

end and effect of head injuries among adolescent, this study collected traumatic brain injury of adolescent from Taipei city an

d Hualian county. The data was undertaken from 20 hospitals of Taipei and 4 hospitals of Hualian, between January 1, 1995 a

nd December 31, 2004; there were 4,999 patients containing adolescent aged between 10 and 19 with traumatic brain injury. T

he trend and variations of clinical histories among the ten years were collected retrospectively, and the cause of death, severity

and prognosis were compared between urban and rural. Between 1995 and 2004, the age-adjusted incidence rate of traumatic

brain injuryfor adolescent in Taipei city was 100 per 100,000 population and 151 per 100,000 population in Hualian county; t

he fatality rate in Taipei city was 6.6 per 100,000 population and 7.3 per 100,000 population in Hualian county. Further analy

sis was performed on the cause of injury, symptoms and outcomes. The results showed that the majority of traumatic brain inj

ury patients aged 10-19 were males (67.8%) and the male to female ratio was about 2 : 1. When the traumatic brain injury inci

dence rate for different age groups from adolescent compared with subgroups aged 10-14 and 15-19, assosciated falling was t

he leading cause for age group 10-14, whereas assosciated traffic accident was the major cause for age group 15-19. Overall, t

he frequency of traumatic brain injury among adolescent was correlated with increasing age, age group 17-19 mostly. On the

aspect of cause of injury, traffic accident was the most in both area, following falling and assult. On the aspect of injury patter

n, 13.5 % were skull fractures, 31 % were unconscious, 11.6 % were suffered from posttraumatic amnesia, 1.8 % got spasm af

ter injuries, and 25.2 % had intracranial hemorrhage. In 1995-2004, traumatic brain injury incidentce rate was discovered that

a constant decreasing trend was existed between 1998 and 2001, but it began to increase again from 2001, which was worth n

oting. Many factors could be attributed to the increase; part of them might due to the intervention of helmet law enforcement s

ince 1997, but it was not strictly observed by the public, which caused a rebound of incidentce in 2001. This study shows that

the present high incidentce rate on traumatic brain injury among adolescent; the impact caused by consequences such as death

s, disability and social economic was much greater than other age groups. Therefore, it is suggested that, in the future, injury p

revention in adolescent should be reinforced; the preventive intervention of traffic accident for age group 15-19 should be the

main point, whereas the falling preventive intervention should be the major direction for age group 10-14.