Elsevier

Surgical Neurology

Volume 66, Supplement 2, November 2006, Pages S14-S19
Surgical Neurology

Trauma
Head injuries in adolescents in Taiwan: a comparison between urban and rural groups

https://doi.org/10.1016/j.surneu.2006.08.029Get rights and content

Abstract

Background

Data pertaining to head injuries in adolescents in Taiwan are scarce. The purpose of this study was to investigate the trend and pattern of head injuries in adolescents in both urban and rural areas in Taiwan.

Methods

We collected data from major hospitals in the urban (20) and fsin the rural (4) areas of Taiwan for a period of 3 years. Data were obtained from the Head Injury Registry, a 10-year electronic database of head injury in Taiwan. The inpatient medical records of adolescents with head injury were thoroughly reviewed. Severity of head injury was classified by the GCS score, and patient outcome at discharge from hospital was measured by the Glasgow Outcome Scale. Differences and correlation between study groups (13-15 and 16-18 years old) in the urban and rural areas were examined using 2-tailed t and χ2 tests.

Results

A total of 469 head injury cases in the urban area and 131 in the rural area were identified. Traffic accidents were the major cause of head injury, and motorcycles were the most predominant vehicles causing traffic accidents in both urban and rural areas. Intracranial hemorrhages were the most prevalent injury pattern in the study population. In both urban and rural areas, the severities of injury were not significantly different (P = .184), but the outcomes at discharge were significantly better in urban areas (P = .032). The correlation between the initial GCS and outcomes in both areas was significant (P < .001). Craniotomy was performed more frequently in the rural area than in the urban area (15.3% vs 7.2%). The mean hospital stay was shorter in the latter than in the former (P < .001). Education on helmet use, input of neurosurgical staff, and facility and emergency medical transportation service of head-injured patients following guidelines proposed by the WFNS are crucial for head injury and better control in rural areas.

Conclusions

The causes, patterns, and outcomes of head injury were statistically different between the 2 age groups of adolescents in urban and rural areas. Further studies on adolescent head injury are necessary.

Introduction

Since 1989, patients with head injury have had a 10-fold higher mortality than those bluntly traumatized without head injury [15]. Head injury is the leading cause of death in accidents, and motorcycle-related traffic accidents compose the majority (71%) of accidents in Taiwan [3], [5], [9], [12], [13], [20]. In the analysis of age groups with accident mortality, the 10- to 19-year age group had the highest mortality rate, especially in the 15- to 19-year age group [3], [14], [18], [21], [22]. As most victims of motorcycle-related head injuries were young, the resulting cognitive, psychological, and neurologic sequelae were overwhelmingly damaging to society [3]. How to prevent and control the mortality and morbidity of head injury in adolescents is therefore a challenging problem in Taiwan.

A long-term trend (1989-2000) showed that fatal head injuries in the age group from 15 to 20 years were decreasing [18]. On June 1, 1997, the helmet use law was implemented in Taiwan. Thereafter, the number of motorcycle-related head injuries and the severity of injury decreased, and better outcomes were obtained [3]. However, data regarding current status of head injuries in adolescents, especially the differences between urban and rural areas are lacking in Taiwan. Therefore, we conducted this study to investigate the distributions and patterns of head injuries in adolescents in both the urban and rural areas in Taiwan.

Section snippets

Data collection

The data of patients with TBI in Taipei and Hualien were extracted from the Head Injury Registry. In the setting of the study, Taipei is defined as the urban area and Hualien County is defined as the rural area. These 2 areas differ in population density, the density and distribution of neurosurgical centers, manpower personnel, and facilities.

Taipei City is the capital of Taiwan. It covers an area of 271.8 km2 and has a population of 2 630 000, with a population density of 9737/km2. There are 20

Results

During the survey period, 469 adolescents (127 in JHS, 342 in SHS) with head injuries in the urban area and 131 (46 in JHS, 85 in SHS) in the rural area were identified. In the urban area, there were 306 (65%) teenaged boys and 163 (35%) girls with a male to female ratio of 1.9. In the rural area, there were 78 (60%) boys and 53 (40%) girls with a ratio of 1.5.

Discussion

The head injury rate in Taiwan is still very high [9], [12], [20]. It was reported that the incidence rate was near 2-fold higher in the rural area than in the urban area [3], [9], [12], [20]. After the enactment of preventive policies, the incidence rate and mortality from head injury decreased in various countries [3], [15], [21]. Therefore, we conducted this study to examine the head injury rate of adolescents in both urban and rural areas in Taiwan after the helmet use law was enforced. The

Conclusions

The difference in causes, patterns, and outcomes of head injury between the 2 age groups of adolescents disclosed the clinical significance of subdivision in adolescents into JHS and SHS groups. Continuing studies, enhanced community interventions, and additional preventive strategies are clearly needed.

Acknowledgments

This study was supported by research grants DOH94-TD-B-111-002 from the Department of Health, Executive Yuan, Taiwan, NHRI-EX94-9106PN from the National Health Research Institute, NHRI-EX95-9106PN from the Topnotch Stroke Research Center Grant, Ministry of Education, the National Health Institute, and grant 94 MMH-TMU-18 from the Collaborative Research Foundation of Mackay Memorial Hospital and Taipei Medical University (Taipei, Taiwan). We gratefully acknowledge the contributions of the

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    M.-F. Chiang and W.-T. Chiu contributed equally to this work.

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