An epidemiological study of head injury in Hualien County, Taiwan
Hung, C.C.; Chiu, W.T.; Tsai, J.C.; Laporte, R.E.; Shih, C.J.
Journal of the Formosan Medical Association 90(12): 1227-1233
1991
ISSN/ISBN: 0929-6646 PMID: 1686894 Document Number: 376448
An epidemiological study of head injuries in Hualien County, Taiwan, was undertaken from 1 July 1987 to 30 June 1988. Clinical records, including emergency room (ER) charts, inpatient charts from the four major hospitals and coroner or medical examiner reports in this county, were reviewed. A formulated definition was used in identifying patients with head injury. A total of 1,183 cases were identified. They included 975 hospital inpatients and 208 nonhospital deaths. The age-adjusted incidence rate for head injuries was 333/100,000 for all, 450/100,000 for males and 194/100,000 for females, with a male-to-female ratio of 2.32. The cumulative incidence rate from 0 to 69 years of age was 27.6% for males and 13.7% for females. The highest incidence rate was observed in the elderly group, whereas in other published reports the highest occurrence has been noted in the young adult group. An extraordinary 82% of the head injuries were associated with traffic accidents, 71% of which directly involved motorcycle riders. The age-adjusted mortality rate was 89/100,000 per year, 127/100,000 for males and 44/100,000 for females. The cumulative mortality rate was 8.7% for males and 3.2% for females. These are the highest rate ever reported. Sixty percent of the 1,183 patients had a moderate to severe injury or were dead. In the remaining 40%, the injury was considered mild. The elderly group presented with the highest percentage of moderate to severe degrees of injury, as well as mortality. Among traffic accident victims, those from motorcycle accidents and pedestrians had the highest percentage of severe head injuries. The Glasgow Outcome Scale was used to evaluate the outcome of subjects. About two-thirds (69.3%) of the subjects had a good recovery, 17.2% suffered moderate or severe disability, 2.5% remained in a persistent vegetative state, and 11.1% died. The outcome of patients appeared to be worse than in other studies. It is recommended that in future studies, the definition, as well as the severity and outcome classifications, be standardized to pave the way for more accurate international comparisons. An international collaborative effort is called for, as the problem of head injuries affects the whole world.