臺灣博碩士論文加值系統

兒童事故傷害一直以來都是公共衛生上的一大問題，不論國內外都是造成兒童死亡的首要原因。本研究將針對台灣北部地區0-14歲因事故傷害至急診就醫之兒童，探討其事故傷害之性別、年齡、受傷時間分佈、發生的原因、傷害的型態及嚴重度，並針對較常發生之兒童事故傷害，找出相關之危險因子。本研究對象來自民國90年2月1日至91年1月31日台灣北部地區五家醫院的創傷病患。共收集1,430名事故傷害之兒童。以10-14歲年齡層兒童居多（36.2％），男女比為1.5；事故發生原因以交通事故（42.5%）最多，其次為跌落（36.9%）；事故發生時間主要在5-8月，時段以上午十點至十二點及下午四點至六點為多。受傷嚴重度〈Injury Severity Score〉中，輕度傷害者佔60.8%，中重度傷害佔30.4%；受傷部位以四肢傷害最多（73.2%）；受傷診斷則以四肢骨折最多（上肢30.1%，下肢21.0%）。造成嚴重傷害之交通事故的危險因子包括母親年齡50歲以上（50-59歲OR=2.13，95%CI 1.15-2.21；60歲以上OR=3.23，95％CI 2.21-3.34），母親教育程度（高中以下OR=4.76，95%CI 3.12-5.53），沒有照顧者在場（OR=2.32，95%CI 1.23-4.48）、沒有防護設備（OR=38.9，95%CI 2.32-44.4）及相關之受傷部位（頭、胸及四肢）。而造成嚴重傷害之跌落的危險因子也是和交通事故類似包括母親教育程度（高中以下OR=4.62，95%CI 3.32-5.43），沒有照顧者在場（OR=4.32，95%CI 1.34-4.48）、沒有防護設備（OR=34.1，95%CI 33.3-143.2）及頭部受傷。兒童事故傷害的發生，雖不能完全避免，但大部份都是可以事先預防的，本研究發現造成兒童交通事故與跌落傷害與照顧者是否在場及發生危險時是否有防護設備為主，今後應多從這兩方面著手。

Childhood injury has always being a major public health issue. It is the main cause of death upon children around the world. Our study will be focused on children at age group of 0-14 years old who had admit to an emergency department located in the northern region of Taiwan due to injury. Topics on sex, age, distribution of time of injury, the cause of injury, the morphology and severity of injury will be discussed. Furthermore, emphasis will be placed upon frequently occurred injuries to find its related risk factors. Samples were obtained from five hospitals located in northern region of Taiwan from February 1st, 2001- January 31st, 2002. A total of 1,430 cases were collected. Age level of 10-14 has the majority of patients (36.2%); male was 1.5 times higher in ratio; traffic accident was the main cause of childhood injury(42.5%) and was followed by falls (36.9%); majority of injury occurs during the months from May till August especially during the time period from 10-12 A.M. and 4-6 P.M. According to the Injury Severity Score, mild injury occupies 60.8%, moderate and severe injury occupies 30.4%; majority of injuries occurs to the four limbs (73.2%); limb fracture was mostly seen among injured patients (upper limb 30.1%, lower limb 21.0%). The risk factors of severe injury caused by traffic accidents include: mother with age 50 years old and above (50-59 yrs OR = 2.13, 95%CI＝1.15-2.21; 60 yrs and above OR = 3.23, 95%CI ＝2.21-3.34); mother’s educational level (below high school OR = 4.76, 95%CI＝3.12-5.53); whether help or care was provided on site (OR = 2.32, 95%CI＝1.23-4.48); whether a protective equipment was worn (OR = 38.9 95%CI＝2.23-44.4) and related area of injury. Similarly, the risk factors of severe injury caused by falls include: mother’s educational level (above university OR = 4.62, 95%CI＝3.32-5.43); whether help or care was provided on site (OR = 4.32, 95%CI＝1.34-4.48); whether a protective equipment was worn (OR = 34.1, 95%CI＝33.3-143.2) and head injury. Occurrences of childhood injury can be much reduced if more attention is placed upon preventions. Our study has shown both intervention of medical support on site and protective equipment worn during the accident were the major factors that influence the later outcome of the patient. Future study should be focused on these two factors in order to reduce the number of injuries.

第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 4
第三節 名詞界定 5
第二章 文獻探討 7
第一節 兒童事故傷害的資料收集 7
第二節 兒童事故傷害之流行病學 8
第三節 兒童事故傷害之危險因子 15
第四節 兒童事故傷害之防治 17
第三章 研究方法與步驟 19
第一節 研究對象 19
第二節 研究架構 20
第三節 研究工具與資料分析 21
第四章 結果 23
第五章 討論 26
研究限制 32
第六章 結論與建議 33
第一節 結論 33
第二節 建議 35

1. 行政院衛生署統計資料，民91。
2. Murray CJL., Lopez AD. Global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries and risk factors in 1990 and projected to 2000. Geneva: World Health Organization, 1996.
3. Kign AS. Accidents claim 96000 lives, but rate declining for some types. JAMA. 1988, 262(16): 2195.
4. Etter IB, et al. The national safety council’s estimates of injury costs. Public Health Reports. 1987; 102(6): 634-36.
5. Maclennan C, et al. The unmeasured costs of injury. Public Health Reports. 1987, 102(6): 636-37.
6. Runge JW: The cost of head injury [Review]. Emergency Medicine Clinics of North America. 1993, 11(1): 241-53.
7. Gallagher S., Finison K., Guyer B., Goodenough S. The incidence of injuries among 87000 Massachusetts children and adolescents: Results of the 1980-81 Statewide Childhood Injury Prevention Program Surveillance System. Am J Pub Hlth 1984; 74: 1340-1347
8. Danseco E.R., Miller T.R., Spicer R.S. Incidence and costs of 1987-1994 childhood injuries: demographic breakdowns. Pediatrics 2000; 105(2): E27.
9. Holmdahl L., Ortenwall P. Causes and consequences of trauma in Swedish county 1989-1992. Eur J Surg 1997; 163: 83-92.
10. Lindqvist KS., Brodin H. One-year economic consequences of accidents in a Swedish municipality. Accid Anal Prev 1996; 28: 209-19.
11. Lu T.H., Lee M.C., Chou M.C. Trends in injury mortality among adolescents in Taiwan, 1965-94. Injury Prevention 1998; 4(2): 111-115.
12. 李寶璽、白璐。三至六歲兒童意外傷害城鄉的比較研究。國防醫學院公共衛生研究所碩士論文，民國82年。
13. 林國瑞。台中市醫院急診室兒童事故傷害流行病學調查研究。行政院衛生署科技研究發展計畫報告書，民國85年。
14. 趙秀雄。13-16歲少年之意外傷害-對台北市4005位國中生所做一年之觀察研究。醫學研究。1983; 5(2): 1759-1773。
15. Baker S.P., O’Neill B., Haddon W. Jr. Long W.B. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. Journal of trauma 1974; 14(3): 187-96.
16. Kraus JF, Black MA, Hessol N, Ley P, Rokaw W, Sullivan C et al.: The incidence of acute brain injury and serious impairment in a defined population. Am J Epidemiology 1984; 119(2): 186-201.
17. Teasdale G, Jennett B: Assessment of coma and impaired consciousness - a practical scale. Lancet 1974; 11: 81-83.
18. 杜友蘭，葉金川，林芸芸，趙秀雄。台北市幼稚園托兒所兒童意外傷害流行病學之研究。醫學研究1980; 3: 951-966。（16-72）
19. Shinaberger C.S., Anderson C.L., Kraus J.F. Young children who drown in hot tubs, spas, and whirlpools in California: a 26-year survey. American Journal of Public Health 1990; 80(5): 613-614.
20. Dafna E.K., Hassan S., Parminder R. Maternal reports of child injuries in Canada: trends and patterns by age and gender. Injury Prevention 2000; 6: 223-228
21. Chan C.C., Cheng J.C., Wong T.W., Chow C.B., Luis B.P., Cheung W. L., Chan K. An international comparison of childhood injuries in Hong Kong. Injury Prevention 2000; 6(1): 20-23.
22. Durbin D.R., Schwarz D.F., Localio A.R. Mackenzie E.J. Trends in incidence of pediatric injury hospitalizations in Pennsylvania. American Journal of Public Health 2000; 90(11): 1782-1784.
23. Abantanga F.A., Mock C.N. Childhood injuries in an urban area of Ghana a hospital-based study of 677 cases. Pediatric Surgery International 1998; 13(7): 515-518.
24. Parkkari J., Kannus P., Niemi S., Koskinen S., Palvanen M., Vuori I. Jarvinen M. Childhood deaths and injuries in Finland in 1971-1995. International Journal of Epidemiology 2000; 29(3): 516-523.
25. Hu X., Wesson D.E. Fatal and non-fatal childhood injuries in Metropolitan Toronto, 1986-1991. Canadian Journal of Public Health 1994; 85(4): 269-273.
26. Kypri K., Chalmers D.J., Langley J.D., Wright C.S. Child injury morbidity in New Zealand, 1987-1996. Journal of Paediatrics & Child Health 2001; 37(3): 227-34.
27. Agran P.F., Winn D., Anderson C., Trent R., Walton-Haynes L. Rates of pediatric and adolescent injuries by year of age. Pediatrics 2001; 108(3): 45-55.
28. Kypri K., Chalmers D.J., Langley J.D. Wright C.S. Child injury mortality in New Zealand 1986-1995. Journal of Paediatrics and Child Health 2000; 36(5): 431-439.
29. Morrison A., Stone D.H. Unintentional childhood injury mortality in Europe 1984-93: a report from the EURORISC Working Group. Injury Prevention 1999; 5(3): 171-176.
30. Grossman D.C. The history of injury control and the epidemiology of child and adolescent injuries. Future of Children 2000; 10(1): 23-52.
31. Ness V., Hoskins R., Robb A. The use of childhood injury surveillance within a general accident and emergency department. Accident and Emergency Nursing 2002; 10(3): 170-176.
32. Burt C.W., Fingerhut L.A. Injury visits to hospital emergency departments: United States, 1992-95. Vital and health statistics - Series 13: Data From the National Health Survey 1998. （131）: 1-76.
33. Adesunkanmi A.R., Oginni L.M., Oyelami A.O. Badru O.S. Epidemiology of childhood injury. Journal of Trauma 1998; 44(3): 506-12.
34. Health Canada. For the safety of Canadian children and youth: from injury data to preventive measures. Ottawa, Canada: Minister of Public Works and Government Services, Canada, 1997.
35. Center for Research and Prevention of Injuries among the Young. Greek injury data from Emergency Department Injury Surveillance System（EDISS）. Greece: CEREPRI, 1995.
36. Guyer B., Ellers B. Childhood injuries in the United States — Mortality, morbidity, and cost. AJDC 1990; 144: 649-652
37. Klauber MR., Barrett-Connor E., Hofstetter CR., Micik SH. A population- based study of nonfatal childhood injuries. Prev Med 1986; 15: 139-49.
38. Brenner RA., Overpeck MA., Trumble AC., DerSimonian R., Berendes H. Deaths attributable to injuries in infants in the United States: 1983-1991. Pediatrics 1999; 103: 968-74.
39. Laffoy M. Childhood accidents at home. Ir Med J 1997; 90: 26-7.
40. Matheny AP. Injuries among toddlers: contributions from child, mother, and family. In: Chess S., Thomas A., Hertzig M., editors. Annual progress in child psychiatry and child development 1987. New York: Brunner/Mazel, 1988. p.521-35.
41. Greaves P., Glik DC., Kronenfeld JJ., Jackson K. Determinants of controllable in-home child safety hazards. Health Edu Res 1994; 9: 307-15.
42. Faelker T., Pickett W., Brison RJ. Socioeconomic differences in childhood injury: a population based epidemiologic study in Ont., Canada. Inj Prev 2000; 6: 203-8.
43. Harel Y. Family psychosocial contributors to childhood injuries. Unpublished doctoral dissertation, University of Michigan, 1988.
44. Bobak M., Pikhart H., Koupilova I. Maternal socioeconomic characteristics and infant mortality from injuries in the Czech Republic 1989-92. Inj Prev 2000; 6: 195-8.
45. Berg MD., Cook L., Corneli HM., Vernon DD., Dean JM. Effect of seating position and restraint use on injuries to children in motor vehicle crashes. Pediatrics 2000; 105: 831-5.
46. Macarthur C., Hu X., Wesson DE., Parkin PC. Risk factors for severe injuries associated with falls from playground equipment. Accident Analysis & Prevention 2000; 32(3): 377-82.
47. Kraus J.F., Fife D., Cox P., Ramstein K., Conroy C. Incidence, severity, and external causes of pediatric brain injury. American Journal of Diseases of Children 1986; 140(7): 687-93.
48. JennettB., Murray A., MacMillan R., Macfarlane J., Bentley C., Strang I., Hawthorne V. Head injuries in Scottish hospitals. Scottish Head injury Management Study. Lancet 1977; 10: 696-698.
49. Reinberg O., Reinberg A., Tehard B., Mechkouri M. Accidents in children do not happen at random: predictable time-of-day incidence of childhood trauma. Chronobiology International 2002; 19(3): 615-31.
50. Adesunkanmi A.R., Oseni S.A., Badru O.S. Severity and outcome of falls in children. West African Journal of Medicine 1999; 18(4): 281-5.
51. 蔡宛真，邱文達，邱弘毅。台灣地區兒童頭部外傷之探討。台北醫學大學傷害防治學研究所碩士論文，民國91年。
52. Huang S.C., Liu T.K. Injuries of extremities in childhood accidents. J Orth Surg ROC 1988; 5: 220-230.
53. Lam L.T., Ross F.I., Cass D.T. Children at play: the death and injury pattern in New South Wales, Australia, July 1990-June 1994. J Paediatr Child Health 1999; 35: 572-577.
54. Stylianos S., Eichelberger MR.：Pediatric trauma. prevention strategies. Pediatric Clinics of North America. 1993; 40(6): 1359-68.
55. Kellermann AL., Todd KN. Injury Control. In:Tintinalli JE., Kelen GD., Stapczynski JS eds. Emergency Medicine: A Comprehensive Study Guide. 5th ed. New York, NY: McGraw Hill 2000:1735-1738.
56. Hargarten SW., Karlson T.：Injury control. A crucial aspect of emergency medicine. Emergency Medicine Clinics of North America. 1993; 11(1): 255-62.
57. Guyer B., Picree KH., Aqran PF. Introduction: a history of injury prevention. In: Injury Prevention-Meeting the Challenge. Am J prev Med 1989; 5（Suppl）: 4-18
58. National Highway Traffic Safety Administration, Centers for Disease Control and Prevention, Federal Highway Administration. National Strategies for Advancing Bicycle Safety. Washington（DC）: U.S. Department of Transportation, National Highway Traffic Safety Administration; 2001.
59. Childhood Injury Fact Sheet, National Center for Injury Prevention and Control, Center for Disease and Control（CDC）, 2003. Available from: URL: http://www.cdc.gov/ncipc/
60. 蔡卓城，邱文達，陳瑞杰。使用外傷登錄初步探討台灣地區之傷害型態
－以六家醫院為例。台北醫學大學傷害防治學研究所碩士論文，民國91年。