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題名:受虐與非受虐兒童傷害型態及醫療利用之差異
書刊名:護理暨健康照護研究
作者:鄭倩樺鍾其祥簡戊鑑
作者(外文):Cheng, Chien-huaChung, Chi-hsiangChien, Wu-chien
出版日期:2012
卷期:8:1
頁次:頁24-33
主題關鍵詞:兒童虐待傷害全民健保資料庫Child abuseInjuryNational Health Insurance Research Database
原始連結:連回原系統網址new window
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  • 共同引用共同引用:32
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背景: 遭受虐待將嚴重影響兒童身心安適。然而受虐兒童就醫時,礙於兒童表達能力受限、又因施虐者或父母在主訴傷害原因時,常避重就輕、或歸咎於意外,以致醫護人員無法在第一時間查覺兒童受虐,因此難以提供受虐兒童及時的協助。 目的: 分析未滿 19歲之受虐及非受虐(非蓄意性傷害)住院兒童傷害類型及醫療利用之差異,藉以找出兒童受虐的預測因子,作為醫護人員之參考,以早期辨識高風險之受虐兒、保障受虐兒童的安全。 方法: 使用 2009年全民健保資料庫,選取國際疾病分類第九版臨床修訂版(ICD-9-CM),受虐個案(N-code 995.5x與 E-code E967.x)及非受虐個案(非蓄意性傷害; E800-E949),使用統計軟體 SPSS 18.0進行資料分析。 結果: 受虐兒童平均年齡低於非受虐兒童(4.8歲 vs. 11.9歲);較多為低收入戶(10.3% vs. 3.7%)、顱內損傷(33.3% vs. 15.6%)及中毒(5.7% vs. 1.9%)的比例均高於非受虐兒童;受虐兒童身上有 2處(含)以上傷害的比例高達 59.8%;受虐兒童平均住院天數(8.8天 vs. 4.9天)、平均醫療費用(79455.7元 vs. 36344.9元)及住院死亡比例(3.4% vs. 0.6%),均顯著高於非受虐兒童。年齡小於三歲、低收入戶、顱內損傷、中毒、傷害部位 2處(含)以上及醫療費用是兒童受虐的預測因子。 結論: 相較於非受虐兒童,受虐兒童年齡較低、發生顱內損傷風險較高,醫療費用等各項醫療利用也較多,實務應用醫療專業人員可利用各種預測因子,辨別受傷兒童是否為暴力受虐者,以提高對於受虐者的保護。
Background: Child abuse is a serious threat to the physical and psychosocial well-being of the pediatric population. Many abused children who visit hospitals may not be recognized as child abuse victims due to non-specificity of injury complaints. Purpose: This study compared the injury and medical service utilization profiles of child abuse victims and their non-abused (accidental injury) peers in the hospital. Methods: This research analyzed data on “inpatient expenditures by admissions” and “registry for contracted medical facilities” in the 2009 National Health Insurance (NHI) database using SPSS 18.0 software. We defined child abuse cases as ICD-9-CM N-code 995.5x and E-code E967.x and controls as E800-E949. Results: Of the 20,720 physical injury cases identified, 87 (0.42%) were identified as child abuse. Coded child abuse victims had a significantly lower mean age than accidental trauma patients (4.8yrs vs. 11.9yrs) and were more likely to come from low-income households (10.3% vs. 3.7%). Coded child abuse victims were also more likely to suffer intracranial injury (33.3% vs. 15.6%) and poisoning (5.7% vs. 1.9%), have more than 2 injury sites (59.8% vs. 40.3%), stay in the hospital longer (8.8 days vs. 4.9 days), and have higher average medical expenditures (NTD79,455.7 vs. NTD36,344.9). Predictors of coded child abuse included an age below 3 years, coming from a low-income household, intracranial injury, poisoning, more than 2 injury sites and relatively high medical expenditures. Conclusion: This study highlights several indicators of child abuse observable during medical visits. Medical professionals may use these to detect abuse victims and potentially protect patients from further abuse.
期刊論文
1.邱鈺鸞、白璐、鍾其祥、蔡沛然、簡戊鑑(20101200)。臺灣1997~2008年受虐住院兒童傷害特性及趨勢。亞洲家庭暴力與性侵害期刊,6(2),65-81。new window  延伸查詢new window
2.丘彥南、江惠綾(20100700)。兒童虐待。臺灣醫學,14(4),431-435。  延伸查詢new window
3.紀琍琍、紀櫻珍、吳振龍(20070700)。兒童虐待及防治。北市醫學雜誌,4(7),531-540。  延伸查詢new window
4.傅惠君、卓妙如(20061200)。護理人員在兒童虐待議題中的角色功能。領導護理,7(2),1-10。  延伸查詢new window
5.陳秀峯(20100700)。臺灣家庭暴力防治之現狀與未來--從被害人保護及加害人處遇角度觀察。亞洲家庭暴力與性侵害期刊,6(1),187-210。new window  延伸查詢new window
6.林佩儀(20040400)。兒童虐待成因探討。諮商與輔導,220,2-9。  延伸查詢new window
7.陳宜彣、葉莉莉、馮瑞鶯(20090800)。兒童虐待之概念分析。護理雜誌,56(4),71-76。new window  延伸查詢new window
8.陳予修、黃志中(20090600)。臺灣護理論述中的婚姻暴力。護理雜誌,56(3),36-45。new window  延伸查詢new window
圖書
1.內政部統計處(2011)。內政部統計年報。臺北:內政部。  延伸查詢new window
其他
1.李建璋(Li, C. C.)(2006)。辨識兒童身體虐待(Identify child physical abuse)。  延伸查詢new window
2.黃郁晴、陳素里(Huang, Y. C., & Chen, S. L.)(2010)。一位多次遭受家庭暴力個案之急診護理經驗(The nursing experience of emergency-department care for a patient suffering from multiple episodes of domestic violence)。  延伸查詢new window
3.L. Bull(2006)。Children’s non-accidental injuries at an accident and emergency department: Does the age of the child and the type of injury matter?。  new window
4.D. P. Bullock, K. J. Koval, K. Y. Moen, B. T. Carney & K. F. Spratt(2009)。Hospitalized cases of child abuse in America: Who, what, when, and where。  new window
5.D. C. Chang, V. Knight, S. Ziegfeld, A. Haider, D. Warfield & C. Paidas(2004)。The tip of the iceberg for child abuse: The critical roles of the pediatric trauma service and its registry。  new window
6.J. Y. Feng, & M. Levine(2005)。Factors associated with nurses’ intention to report child abuse: A national survey of Taiwanese nurses。  new window
7.T. Fujiwara, M. Okuyama & M. Miyasaka(2008)。Characteristics that distinguish abusive from nonabusive head trauma among young children who underwent head computed tomography in Japan。  new window
8.R. Gilbert, C. S. Widom, K. Browne, D. Fergusson, E. Webb & S. Janson(2009)。Burden and consequences of child maltreatment in high-income countries。  new window
9.W. J. King, M. MacKay & A. Sirnick(2003)。Shaken baby syndrome in Canada: Clinical characteristics and outcomes of hospital cases。  new window
10.W. G. Lane, H. Dubowitz, S. Feigelman, J. Kim, L. Prescott, W. Meyer, & J. K. Tracy(2007)。Screening for parental substance abuse in pediatric primary care。  new window
11.W. G. Lane, I. Lotwin, H. Dubowitz, P. Langenberg & P. Dischinger(2011)。Outcomes for children hospitalized with abusive versus noninflicted abdominal trauma。  new window
12.J. M. Leventhal, K. D. Martin & A. G. Asnes(2010)。Fractures and traumatic brain injuries: Abuse versus accidents in a US database of hospitalized children。  new window
13.A. V. Levin & C. W. Christian(2010)。The eye examination in the evaluation of child abuse。  new window
14.M. O’Donnell, N. Nassar, H. Leonard, R. Mathews, Y. Patterson & F. Stanley(2010)。Monitoring child abuse and neglect at a population level: Patterns of hospital admissions for maltreatment and assault。  new window
15.N. K. Pandya, K. Baldwin, H. Wolfgruber, C. W. Christian, D. S. Drummond & H. S. Hosalkar(2009)。Child abuse and orthopaedic injury patterns: Analysis at a level I pediatric trauma center。  new window
16.S. Rovi, P. H. Chen & M. S. Johnson(2004)。The economic burden of hospitalizations associated with child abuse and neglect。  new window
17.D. M. Rubin, C. W. Christian, L. T. Bilaniuk, K. A. Zazyczny & D. R. Durbin(2003)。Occult head injury in high-risk abused children。  new window
18.J. Wood, D. M. Rubin, M. L. Nance & C. W. Christian(2005)。Distinguishing inflicted versus accidental abdominal in juries in young children。  new window
19.World Health Organization(2002)。World report on violencea and health。  new window
20.World Health Organization(2006)。Preventing child maltreatment: A guide to taking action and generating evidence and International Society for Prevention of Child。  new window
 
 
 
 
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