受虐與非受虐兒童傷害型態及醫療利用之差異

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／實務應用：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，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。

關鍵字

兒童虐待；傷害；全民健保資料庫

並列摘要

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.

並列關鍵字

child abuse ； injury ； National Health Insurance Research Database

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受虐與非受虐兒童傷害型態及醫療利用之差異

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