外科急診家暴受害者之外傷表現

Clinical Characteristics of Patients Who Visited the Surgical Emergency Department due to Domestic Violence

許薰元(Shiun-Yuan Hsu) ； 劉宥妘(You-Yun Liu) ； 龔千逢(Chien-Feng Kung) ； 謝青華(Ching-Hua Hsieh)

《健康科技期刊》 5卷1期 (2018/10) Pp. 1-18

https://doi.org/10.6979/TJHS.201810_5(1).0001

摘要

目的：家庭暴力簡稱家暴，是指家庭成員間實施身體或精神上的傷害行為，也是造成急診外傷之常見原因之一。此研究在於闡明從急診外傷所見之家暴現況，並探討家暴受害者之外傷狀況。方法：本研究探討2014年01月01日至2015年12月31日為止二年間因遭受家暴而至急診就醫之所有外傷病患，分別將所有性別、年齡基本資料、家暴施害者成員、受傷部位與機轉、臨床表現、外傷嚴重之程度、治療結果及住院後的醫療費用和死亡率做詳細記錄，並分別做各項資料之呈現。結果：本研究顯示因家暴至急診就醫者有367人，其中8人（2.2%）需要住院治療。受害人以女性居多占291人（79.3%），施虐者以配偶關係比例為最高210人（57.2%），其次是來自兒女為52人（14.2%）。在受傷型態中，鈍挫傷占了絕大多數為358人（97.5%），其次為跌落6人（1.6%）及穿刺傷 3人（0.8%）。以受傷部位而言，頭頸部受傷和外觀軟組織受傷為大多數，分別有129人（35.1%）和124人（33.8%），其次則是四肢受傷共91人（24.8%）及臉部受傷共81人（22.1%）。病患的傷害嚴重程度評分平均為1.5 ± 1.7分，但對於需要住院之病患，其傷害嚴重程度評分平均為8.0 ± 7.6分。在急診治療後可以出院的病人（n=359）都是存活的，但是於急診治療後需住院患者（n=8）之中有一人死亡，其受傷機轉為水果刀刺傷腹部，造成出血性休克後併發腦損傷而死亡。住院家暴受害人之整體醫療費用為198,326 ± 265,866元、檢查費用為12,065 ± 19,657元、藥費為23,381 ± 46,870元、手術費用則為31,989 ± 30,278元。結論：家暴所造成之外傷可能造成受害人不同部位之骨折或內臟器官損傷情況，而需要住院及手術治療，甚至還有可能造成家暴受害人死亡之情況發生。闡明家暴受害者於外科急診之臨床表現，將有助於描繪出家暴受害者之外傷狀況，作為家暴防治之參考，並藉以提倡一個無家暴的生活環境。

關鍵字

外傷 ； 急診 ； 家暴

並列摘要

Objective: Domestic violence, a common reason for a visit to the surgical emergency department, constitutes a serious social and psychological problem with harmful consequences to the psychological and physiological functioning of the victim. This study aimed to profile the clinical characteristics of patients who visited the emergency department due to domestic violence. Method: Patients who had visited the surgical emergency department due to traumatic injury from domestic violence between January 1, 2014, and December 31, 2015, were included in this study with retrieval of the following information: age, sex, perpetrator of violence, injury region and mechanism, clinical presentation, injury severity, outcome, expenditure after admission, and in-hospital mortality, for further presentation. Results: 367 patients were included in this study who had visited the surgical emergency room as victims of domestic violence; among them, 8 (2.2%) patients required an admission for treatment. Most of the victims (n = 291, 79.3%) were female. 210 (57.2%) and 52 (14.2%) patients had been abused by spouses and children, respectively. The analysis of injury mechanism discovered that 358 (97.5%) patients sustained a blunt injury, followed by fall (n = 6, 1.6%) and penetrating injury (n =3, 0.8%). Most injuries were found in the head/ neck (n = 129, 35.1%) and external (n = 124, 33.8%) regions, followed by the extremities (n = 91, 24.8%) and face (n = 81, 22.1%). The average Injury Severity Score (ISS) was 1.5 ± 1.7. However, the average ISS of those eight hospitalized patients was 8.0 ± 7.6. All patients who were discharged from the emergency department after treatment survived; in contrast, of those hospitalized patients, one patient, who had sustained brain damage following profound shock after a penetrating injury into the abdomen by fruit knife, was fatal. The average total expenditure was 198,326 ± 265,866 New Taiwan (NT) dollars, with cost of examination, cost of pharmaceuticals, cost of operation being 12,065 ± 19,657, 23,381 ± 46,870 and 31,989 ± 30,278 NT dollars, respectively. Conclusion: Domestic violence may result in fractures of different regions or injuries to the visceral organs that require hospitalization or operation, and may even cause the death of the victim. Elucidation of the clinical characteristics of the patients who sustained trauma injures from domestic violence may help to profile the condition of the victims, serve as references for protection measure for domestic violence, and advocate living environments free from domestic violence.

並列關鍵字

trauma ； emergency department ； domestic violence

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