| 摘要: | 一、研究動機與目的
（一）探討汽車安全帶對汽車事故頭部外傷嚴重度、預後結果的影響。
（二）探討城鄉地區腳踏車事故頭部外傷住院病人特性、嚴重度、預後結果之差異。
（三）以世界衛生組織障礙評估手冊2.0版（World Health Organization Disability Assessment Schedule, WHODAS 2.0）比較脊髓損傷與頭部外傷殘障者之失能情形。
二、重要研究方法
（一）汽車事故頭部外傷：2001年6月1日至2013年5月31日共收集822名汽車事故頭部外傷住院病人，分析是否繫安全帶之頭部外傷情形、嚴重度、預後結果間差異。
（二）於1998年7月1日至2013年6月30日收集台北、花蓮共812名腳踏車事故頭部外傷住院病人，進行城鄉地區事故發生情形、安全帽使用情形、頭部外傷情形、嚴重度、預後結果之分析比較。
（三）分析衛生福利部建置之全國國際健康功能與身心障礙分類系統，於2012年9月1日至2013年8月31日共收集2,664頭脊髓損傷殘障者，其中1,316名為頭部外傷殘障者、1,348名脊髓損傷殘障者。
三、研究結果
（一）強制執行汽車駕駛與前座乘客需繫安全帶法案後，頭部外傷嚴重度明顯較輕（P < 0.001），發生意識喪失、神經障礙、顱內血腫、執行開顱手術及出院時預後結果差的比率明顯較低（所有 P < 0.05）。男性、住院時間較長、未繫安全帶、執行安全帶法案前與預後結果差有關（所有 P < 0.01）。
（二）都市腳踏車事故頭部外傷者多為19至34歲、在慢車道受傷；而鄉村腳踏車頭部外傷傷者中有33.7%為65歲以上之年長者、在快車道發生事故。戴安全帽者較未帶安全帽者入院時嚴重度較輕、出院時預後結果較佳。
（三）相較於脊髓損傷者，頭部外傷族群在認知、自我照護、與他人相處、生活自理、社會參與能力較差。影響WHODAS 2.0分數的因素包括年齡、性別、受傷型態、社會經濟地位、安置場所以及嚴重度。
四、結論
（一）汽車事故頭部外傷住院病人中，有繫安全帶者預後結果較佳，安全帶可減少汽車事故受傷嚴重度。
（二）城鄉腳踏車頭部外傷特性之差異，及戴安全帽對腳踏車事故頭部外傷之保護效果，可作為預防腳踏車事故、降低腳踏車事故頭部外傷嚴重度之參考。
（三）WHODAS 2.0分數可全面性反映障礙情形，未來研究需要以多元的觀點評估WHODAS 2.0在頭部外傷及脊髓損傷族群分數。
Background:
The purpose of this study was (1) to determine the effect of motor vehicle seat belt use on the severity of traumatic brain injuries because of motor vehicle accidents. (2) to investigate the different characteristics and clinical outcomes of traffic-accident related head injuries to cyclists in urban and rural areas. (3) to compare traumatic brain injuries (TBI) and spinal cord injuries (SCI) patients’ function and disability by using the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0); and to clarify the factors that contribute to disability.
Methods:
Data were collected from 26 major teaching hospitals four years before June 1, 2001 and until May 31, 2013. A total of 822 brain-injured patients were included; 251 were injured prior to implementation of the law and 571 after.
Records of 812 patients admitted to 26 hospitals in Taipei City and Hualien County as the result of a traumatic head injury while bicycling between 1998 and 2013 were retrieved for study. Demographics, details about the accident, protective helmet use, and clinical outcomes were then subject to analysis.
We analyzed data available between September 2012 and August 2013 from Taiwan’s national disability registry which is based on the International Classification of Functioning, Disability, and Health framework. Of the 2664 cases selected for the study, 1316 pertained to TBI and 1348 to SCI.
Results:
After the seat belt law was implemented, traumatic brain injuries were less severe (P<0.001) and the rates of loss of consciousness, neurologic deficit, intracranial hematoma, craniotomy, and poor physical condition at discharge were all significantly lower (all P< 0.05). Male gender, longer hospital stays, not wearing a seat belt, and injury before the law was enacted were all associated with poorer physical condition at the time of discharge (all P <0.01).
Most urban victims were between 19 and 34 years of age and injured in the slow lane. Rural victims tended to be younger or older and were injured in the fast lane. Riders who did not wear a helmet were more likely to suffer moderate-severe head injuries and more permanent damage.
A larger percentage of patients with TBI compared with those with SCI exhibited poor cognition, self-care, relationships, life activities, and participation in society (all p < 0.001). Age, sex, injury type, socioeconomic status, place of residence, and severity of impairment were determined as factors that independently contribute to disability (all p < 0.05).
Conclusion:
Among occupants who survived a motor vehicle accident but had traumatic brain injuries, those who had worn seat belts had a better prognosis. Seat belts remain one of the best methods to reduce both the severity of injuries and the number of fatalities.
Differences in the characteristics of injuries in urban and rural areas and the utilization of protective helmets may help government authorities adopt appropriate policies to promote safer and more enjoyable cycling.
The WHODAS 2.0 is a generic assessment instrument which is appropriate for assessing the complex and multifaceted disability associated with TBI and SCI. Further studies are needed to validate the WHODAS 2.0 for TBI and SCI from a multidisciplinary perspective. |
