兒童事故傷害調查研究——以臺南某醫學中心為例

The Study of Childhood Accidental Injury: A Medical Center in Southern Taiwan

兒童事故傷害是造成兒童死亡的首要原因。本研究針對台南地區某醫學中心的病童為研究對象，根據外傷登錄系統(E-codes)的分類，搜尋2000年10月至2001年9月期間，因事故傷害至醫院就診的12歲以下病童之病歷，共收集1538份有效個案。結果發現男童事故傷害發生率為女童的1.7倍；年齡則以0-2歲及2-4歲的兒童最多，分別佔24.1%及27.4%，0-6歲兒童共計1064人，約佔總人數的69%。兒童於非假日的傷害人數較多，但假日與非假日的各種事故發生率比例相當；四季的發生率平均都在24-26%之間；一天之中以18點到24點為兒童事故傷害的第一個高峰，佔41.7%。兒童事故傷害發生地點以家中居多，共987人(64.2%)，其次依序為道路、學校以及戶外。跌倒是兒童事故傷害類型中發生率最高者，有530人(34.5%)，接著依序為墜落、一般傷害、車禍、吞入異物、灼傷、中毒與溺水，其中除了車禍、溺水外，大都發生在家中。進一步分析跌倒案例，有48.7%是因為追逐所引起，且在學校事故中，跌倒比率也高達58.0%。至於墜落案例，以從床及桌椅等家具墜落者為最多，這也是0-2歲兒童的最大傷害類型。在一般傷害類型中，以撞擊事故最高(36.9%)，其次是不當使用工具。吞入異物則以吞入錢幣、彈珠、鈕扣為主，常見2-4歲兒童，6歲以下兒童則佔吞入異物事故的90%。兒童灼傷的主因來自於熱水，0-6歲兒童約為6-12歲兒童的三倍。中毒事故幾乎集中在4歲以下兒童，且以藥物中毒為首因。若就事故傷害導致的外傷部位而言，頭臉傷害共計937人，比例高達67.3%，其中0-2歲和2-4歲兒童頭臉部傷害比率分別高達80.1%和74.3%，而不論何種傷害部位都以在家中發生的人數為最多。本研究建議，為預防兒童事故傷害的發生應特別加強居家安全教育以及戶外遊戲場防護設備的改善，且預防跌倒、墜落傷害的防制策略不容忽視。而所有的傷害防制工作應結合社區資源、家庭、學校共同實施，才能為兒童營造一個安全健康的生活環境。

Childhood accidental injuries have been recognized as the leading causes of fatal injuries in children. A total of 1538 consecutive cases of children under 12 years old sustaining trauma which defined by external cause of injury (E codes) were retrieved in National Cheng Kung University Hospital from October 2001 to September 2002. The result showed that 69% of the sample was under 6 years of age, with peaks under the ages of 2 year and between 2 and 4 years (24.1% and 27.4%, respectively). Male predominated over female up to 170%. Accidents occurred more frequently on weekdays; without significant different in seasons; with the peak incidence rate during the time period from 6 to 12 PM. The home was the scene for 64.2% of childhood accidents, followed by streets or roadways, school and outdoors. Slips & tumbles (STs; 34.5%) were the leading causes of childhood injuries, followed by falls, hurts, traffic accident, choking, burns, and poisoning. Detailed inspection of STs cases revealed that 48.7% of these accidents caused by playing and running and 58.0% occurred in school. The falls occurred mostly from furniture, with peaks under the ages of 2 years. A total of 937 children (67.3%) sustained craniofacial injuries, with peaks under the ages of 2 years and between 2 and 4 years (80.1% and 74.3%, respectively). These findings indicated that the home is a potentially dangerous environment for children, and people should pay more attention to eliminate the risk factors in the environment to prevent children from accidents. STs are more prevalent than other causes; however, falls are associated with greater trauma morbidity.