| 摘要: | 道路交通事故傷害是全世界5-14歲兒童的首要殺手，也是全世界5-29歲年青人死亡原因第一名；而在台灣將近一半的道路交通事故死亡中肇因於機車事故。由於目前關於兒童機車事故傷害的研究在文獻中是很缺乏的，因此本研究的目的有三個，第一是估計兒童機車傷害的發生率與相對危險性；第二是測量兒童機車危險行為的盛行率並試著尋找這些危險行為的獨立相關因子；第三則是描述兒童機車傷害的傷害型態，並尋找機車事故後兒童頭部外傷與嚴重傷害(外傷嚴重度分數ISS≧5)的獨立危險因子。
本研究有三個不同的資料來源。第一部分學校回溯資料庫是以彰化市人數最多四間國小的小學生作為研究對象，請班級老師協助發放問卷並透過學童帶回家，由父母填寫問卷，紀錄學童一周的三種道路交通方式(機車、汽車、與步行)的通勤次數(person-trip)，同時調查過去三年內學童的道路交通事故經驗與受傷情況。第二部分道路觀察資料庫則選擇在彰化市唯一一家大型購物中心的機車停車場，派遣訪員當場直接觀察兒童的危險機車行為(不戴安全帽、搭乘在一台超載的機車上面、與搭乘位置在駕駛前方)，並使用結構式問卷對父母機車駕駛進行訪談。第三部分為醫院前瞻資料庫，在彰化縣內最主要的三家大型醫院急診部門，對14歲以下搭乘機車時發生機車事故而受傷送來上述急診室的兒童進行收案，兒童病歷上受傷狀況會被紀錄下來，同時使用結構式問卷對成年駕駛進行兩周後的追蹤電訪來獲得駕駛與事故當時的資料。
在四間小學回收的5,172份有效問卷（回覆率62.6%）中，全部道路交通次數的52.4%為搭乘機車，且過去三年共發生275次機車事故，其中有84次學童遭受需要醫療介入的傷害，故兒童機車事故發生率為每百萬次通勤發生36.72次（95%信賴區間：36.65~36.78次/百萬次道路通勤），而兒童機車傷害發生率則為為每百萬次通勤發生11.22次（95%信賴區間：11.18~11.25次/百萬次道路通勤）；相對於步行，搭乘機車的兒童較容易遭受到需要醫療介入的傷害（勝算比：1.68，95%信賴區間：1.00~2.83）。相對於搭乘汽車，兒童搭乘機車的相對傷害風險更大（勝算比：3.41，95%信賴區間：1.94~6.01）。在道路觀察方面，193位兒童中有40.1%不戴安全帽、47.4%搭乘超載、以及56.8%兒童搭乘位置在駕駛前方。在多變項邏輯式回歸分析中，兒童不戴安全帽的相關因子有兒童本身是男性（勝算比：2.4，95%信賴區間：1.2~4.9）、較小兒童年齡（相較於≧7歲，≦3歲勝算比：3.2，95%信賴區間：1.2~8.5；4-6歲勝算比：3.4，95%信賴區間：1.4~8.1）、駕駛是男性（勝算比：3.7，95%信賴區間：1.7~8.1）、與較年輕的駕駛（相較於34-39歲，≦33歲勝算比：3.6，95%信賴區間：1.6~8.3）。在醫院前瞻資料庫方面，在19個月的研究期間共400位兒童符合我們的收案標準，其中有305位家長同意進入我們的研究。兒童機車傷害最容易受傷部位為四肢（81%）、臉部（42.3%）、與頭部（39.7%），有51.8%的兒童遭受兩個部位以上的多重外傷；總共有34位（11.1%）兒童需要住院治療，其中有8位（2.6%）需要住加護病房。
機車車禍後兒童頭部外傷的獨立危險/保護因子有較小的兒童年齡（相較於≧7歲，≦3歲勝算比：4.08，95%信賴區間：1.32~12.59；4-6歲勝算比：4.06，95%信賴區間：1.50~10.97）、有戴安全帽（相較於沒戴安全帽，全罩式安全帽勝算比：0.32，95%信賴區間：0.08~1.31；半罩式安全帽勝算比：0.28，95%信賴區間：0.13~0.62）、搭乘位置在駕駛前方（勝算比：2.76，95%信賴區間：1.20~6.34）、超載（勝算比：2.21，95%信賴區間：1.02~4.78）、較快的騎乘速度（公里/小時，勝算比：1.03，95%信賴區間：1.00~1.06）、從機車前方或後方撞擊（相對於從側面撞擊或自摔 ，勝算比：2.36，95%信賴區間：1.08~5.15）。
機車車禍後兒童嚴重傷害的獨立危險/保護因子有較小的兒童年齡（相較於≧7歲，≦3歲勝算比：1.67，95%信賴區間：0.39~7.09；4-6歲勝算比：5.81，95%信賴區間：1.52~22.21）、有戴安全帽（相較於沒戴安全帽，半罩式安全帽勝算比：0.25，95%信賴區間：0.07~0.85）、車速較快（公里/小時，勝算比：1.05，95%信賴區間：1.01~1.09）、被拋出機車外（勝算比：4.09，95%信賴區間：1.44~11.66）。
兒童機車傷害的發生率並不低，相對於步行與搭乘汽車，兒童搭乘機車有較高的傷害風險。許多兒童機車的危險行為（沒戴機車安全帽、超載、與前座搭乘）在道路上的盛行率都相當的高。有許多獨立危險因子會影響兒童機車傷害的型態與嚴重程度，其中兒童年齡<7歲、前座搭乘、超載、車速越快、來自機車前方或後方的撞擊、與被拋出機車外會顯著地增加頭部外傷或嚴重傷害的風險，而戴上安全帽則可顯著地下降這些風險。我們建議政府相關部門應該加強取締機車上的兒童乘客不戴安全帽、搭乘位置在駕駛前方、與超載的違規行為，考慮加重搭載兒童時超速的罰款與刑責、並開始研議制定兒童搭乘機車的最低年齡限制。
Road traffic injury is first killer among children aged 5-14 years old and the leading cause of deaths in 5-29 years old young people in the world. In Taiwan, half of the road traffic deaths were associated with motorcycles. Because there was few report concerned about pediatric motorcycle injury in the literature, we have three study purposes: the first is to estimate the incidence of pediatric motorcycle injury and relative risk. The second is to evaluate the prevalence of motorcycling risky behaviors in children and try to identify the independent factors for these risky behaviors. And the last is to describe the injury patterns of pediatric motorcycle injury, and try to identify the independent risk factors for head injury and severe injury (Injury Severity Score, ISS≧5).
Our study had three different data source. The first was school retrospective databank. The study subjects were the students of the leading four elementary schools in Changhua City. School teachers delivered the questionnaires to students, and they brought home to their parents to answer it, including the usage (person-trips) of the road by motorcycle, bicycle, car, and walk, and crash experience with injury detail within the past 3 years. The second was road observation databank. We sent research assistants to the motorcycle parking lot of the only one shopping mall in Changhua City. They interviewed the parental motorcyclists by a structuralized questionnaire and directly observed the risky behaviors of child passengers (unhelmeted, overloaded, and taking the front seat). The third was hospital prospective databank. The study subjects were children aged 14 or less injured after motorcycle crashes and sent to the emergency department of three major hospitals in Changhua County. The injury data of the child was recorded and a following telephone interview by a structuralized questionnaire to the adult motorcyclist was performed 2 weeks later to obtain the motorcyclist and the collision information.
In the 5,172 valid questionnaires (response rate: 62.6%) from the four elementary schools, 52.4% road travel of the students were by motorcycle. There were 275 motorcycle crashes with 84 medical-attentioned injuries in the past 3 years. The incidence rate of motorcycle crash was 36.72 per million person-trips (95% confidence interval (CI): 36.65~36.78), and of motorcycle injury was 11.22 per million person-trips (95% CI: 11.18~11.25). Comparing to walk, children were more likely to suffer from medical-attentioned injuries by motorcycle (odds ratio (OR)=1.68, 95% CI: 1.00~2.83). Comparing to car, children also had higher risk from medical-attentioned injuries by motorcycle. (OR=3.41, 95% CI: 1.94~6.01). In the road observations of 193 children, there were 40.1% unhelmeted, 47.4% overloaded, 56.8% taking the front seat. In the multivariate logistic regression analysis, the independent factors for unhelmeted children were male child passenger (OR= 2.4, 95% CI: 1.2~4.9), younger child age (comparing to age ≧7 years old, age ≦3 years old: OR= 3.2, 95% CI: 1.2~8.5; age 4-6 years old: OR= 3.4, 95% CI:1.4~8.1), male motorcyclist (OR= 3.7, 95% CI:1.7~8.1), and younger motorcyclist (comparing to 34-39 years old, ≦33 years old: OR= 3.6, 95% CI: 1.6~8.3).In the hospital prospective databank, there were four hundred children met our inclusion criteria, and 305 parents participated our study. The most common injury body parts in pediatric motorcycle injury were limbs (81%), face (42.3%), and head (39.7%). There were 51.8% children suffering from two or more body part injuries as multiple trauma. Thirty-four (11.1%) children needed admission, and eight of them admitted to intensive care unit.
The independent risk/protective factors for head injury following motorcycle crashes in child passengers are younger child age (comparing to age ≧7 years old, age ≦3 years old: OR= 3.63, 95% CI: 1.06-12.42; age 4-6 years old: OR= 3.73, 95% CI:1.20-11.61), helmeted (comparing to unhelmeted, full-coverage helmet: OR= 0.38, 95% CI: 0.07-2.20; half-coverage helmet: OR= 0.32, 95% CI: 0.12-0.84), taking the front seat (OR= 2.66, 95% CI: 1.00-7.09), newer motorcycle (comparing to vehicle age ≧10 years, 0-4 years: OR= 7.52, 95% CI: 1.99-28.44; 5-9 years: OR= 1.47, 95% CI: 0.54-4.02) , and more severe injury in adult motorcyclist (comparing to no medical intervention required, medical intervention needed without admission: OR= 4.61, 95% CI: 1.12-18.90; required admission or out of hospital cardiac arrest: OR= 7.93, 95% CI:1.14-55.03).
The independent risk/protective factors for head injury following motorcycle crashes in child passengers are younger child age (comparing to age ≧7 years old, age ≦3 years old: OR= 4.08, 95% CI: 1.32~12.59; age 4-6 years old: OR= 4.06, 95% CI: 1.50~10.97), helmeted (comparing to unhelmeted, full-coverage helmet: OR= 0.32, 95% CI: 0.08~1.31; half-coverage helmet: OR= 0.28, 95% CI: 0.13~0.62), taking the front seat (OR= 2.76, 95% CI: 1.20~6.34), overloading (OR= 2.21, 95% CI: 1.02~4.78), faster speed (km/h, OR=1.03, 95% CI: 1.00~1.06), and head-on or rear-end impact (compare to side impact or single vehicle, OR=2.36, 95%CI：1.08~5.15).
The independent risk/protective factors for severe injury following motorcycle crashes in child passengers are younger child age (comparing to age ≧7 years old, age ≦3 years old: OR= 1.67, 95% CI: 0.39~7.09; age 4-6 years old: OR= 5.81, 95% CI: 1.52~22.21), helmeted (comparing to unhelmeted, half-coverage helmet: OR= 0.25, 95%CI: 0.07~0.85), faster speed (km/h, OR= 1.05, 95% CI: 1.01~1.09), be thrown out of the motorcycle (OR=4.09, 95% CI: 1.44~11.66).
The incidence rate of injury for motorcycle child passengers is not low. Motorcycling has higher injury risk for children when comparing to walk and car. The prevalences of many risky behaviors in motorcycle child passengers, such as unhelmeted, overloaded, and taking the front seat, were very high. Many independent risk factors may affect the injury patterns and severity in motorcycle child passengers. Child age <7 years old, taking the front seat, overloaded, faster speed, head-on or rear-end impact, and be thrown out of the motorcycle may significantly increase the risk of head or severe injuries, while wearing helmets may significantly decrease these risks. We suggest the government should carry out an intensive enforcement of unhelmeted, overloaded, and the front seat riding, and consider increasing the fine and punishment of speeding when motorcycling with a child. The discussion and research may be started on the minimum age limit of the motorcycle child passenger. |
