Ching Chang Hung

A nationwide epidemiological study of spinal cord injury in geriatric patients in Taiwan

This prospective epidemiological survey of spinal cord injury (SCI) in Taiwan was carried out among patients attended by physicians from various medical centers and general hospitals all over Taiwan from July 1992 to June 1996. In all, 1,586 new cases of SCI were registered, representing about 70% of all possible SCI cases in Taiwan. The observed average annual incidence of SCI in Taiwan was 18.8 per million people, whereas it was 47.5 for the geriatric section. The mean age was 46.1 years with a plateau distribution after 20 years and older. Geriatric victims (297 cases, 18.7%, group II) formed a major section of SCI cases in Taiwan. Another group of younger SCI patients (15-64 years old, 1,232 cases, group I) was selected for comparison. The results showed that the male-to-female ratio, pattern of neurological deficits, and causes of injury and death of geriatric SCI patients differed significantly from those of the younger SCI group. Elderly women were exposed to a higher risk of SCI than younger women (M/F ratio 1.7:1). Falls were the leading cause of geriatric SCI, and two thirds of them occurred on level ground. Traffic accidents accounted for a third of SCI cases, half of which involved motorcycle accidents, a fifth of them pedestrians. Quadriplegia and quadriparesis occurred more frequently among elderly cases of SCI than in the younger group and a higher proportion of them died of SCI complications. Two thirds of elderly SCI patients recovered well enough after comprehensive treatment to be able to take care of themselves at home. The government should initiate programs of prevention to reduce the prevalence of geriatric SCI in Taiwan.

Epidemiological study of moyamoya disease in Taiwan.

From January 1978 to December 1995, 92 cases of Moyamoya disease were collected from seven major medical centers in Taiwan. The data gave an annual incidence rate of 0.048 per 100,000 population. There were 40 males and 52 females and the ages ranged from 2 to 62 years with the peak incidence in the 31-40 year age group (23 cases). Cerebral infarction occurred in 20 out of 24 juvenile patients (83%), and in 24 out of 68 adult patients (35%). The difference was statistically significant. Haemorrhagic stroke was more frequent in adult patients. Computed tomographic scans following stroke showed cerebral infarction in 44 cases, ventricular haemorrhage in 26 cases, intracerebral haemorrhage in 14 cases and pure subarachnoid haemorrhage in eight. The most frequent initial symptom was motor disturbance (59%), followed by headache (49%) and impaired consciousness (35%). This survey showed an incidence rate much lower than that in Japan, but comparable with those in other Oriental countries and higher than those in Western countries. The male-to-female ratio once differed considerably from that of the Japanese series, but from the present study is now quite similar.

A nationwide epidemiological study of spinal cord injuries in Taiwan from July 1992 to June 1996

This prospective epidemiological survey of spinal cord injury (SCI) in Taiwan was carried out by recruiting patients attended by physicians from various medical centers and general hospitals all over Taiwan from July 1992 to June 1996. A total of 6,410 cases of traumatic spinal fracture were registered among which were 1,586 new cases of SCI. The results represented 70% of the scope of SCI in Taiwan. The observed average annual incidence of SCI in Taiwan was 18.8 per million population. The mean age was 46.1 years-old with a plateau distribution for over 20 years and older. Geriatric victims are a major group of SCI in Taiwan. The male to female ratio was 3 to 1. The leading causes of SCI were traffic accidents and accidental falls. Motorcycle collisions accounted for 62% of the traffic accidents, and as most of the motorcycle riders were not helmet users, head injury became the major associated injury of SCI in Taiwan. The effectiveness of the comprehensive care system for SCI patients in Taiwan is relatively good, as reflected by the low rates of complications of SCI, the low mortality rate (6.6%) and the high percentage (67.4%) of SCI patients achieving self-care ultimately at home after rehabilitation. The analysis of person days healthy life loss and quality adjusted survival time revealed that SCI patients in Taiwan required 4 years to cope with the morbidity, and on average, could return to the main stream of life for another 30 years.

Pediatric traumatic brain injuries in Taiwan: an 8-year study

Background. This study is intended to determine the causes of pediatric traumatic brain injuries (PTBI) in children aged 14 years or less, and to identify various types of craniocerebral damage resulting from different mechanisms of injury.Methods. From July 1, 1993 to June 30, 2001, a survey on PTBI was conducted in Taiwan. The data of patients used in this study were collected from 56 major hospitals among the age group of 0-14 years. The items in the traumatic brain injury survey included sex, age, causes of injuries, severity, and the eventual outcome.Results. A total of 5349 cases were identified. The male-to-female ratio was 1.69: 1. The incidence rate was higher in the age groups of 4-9 years and 10-14 years. The main cause of PTBI was traffic injury, which accounted for 2537 of the cases (47.3%), followed by falls, 2160 (40.3%). Of all traffic injuries, motorcycle-related injury had the highest incidence, followed by the pedestrian and bicycle-related injury. This study also showed that 83.2% of the patients had mild injury, 9.8% had moderate injury, and 7.0%, severe injury.Conclusions. The results of this study suggest that it is important to decrease all the risk factors in the environment of homes and public areas as much as possible. Helmet wearing and the development of public transportation are essential for the prevention of head injury.

Epidemiology of head injury in rural Taiwan -a four year survey.

An epidemiological study of head injury in Hualien County, Taiwan, was undertaken from January 1, 1988 to December31, 1991. The age-adjusted incidence rate of head injury was 382/100 000, 499/100 000 for males and 244/100 000 for females. The highest incidence rate was observed in the elderly group 70 years or older. It is notable that 79% of head injuries were associated with traffic accidents, 75% of which directly involved motocycle use. The age-adjusted mortality rate was 89/100 000 per year, 125/100 000 for males and 47/100 000 for females. As to the severity of head injury, the elderly group presented the highest percentage of moderate to severe degrees of injury as well as mortality. The victims of motorcycle accidents and pedestrians had the highest percentage of relatively severe head injury. Hospitalised patients showed an outcome worse than that ever reported in the literature.

Head injury in urban and rural populations in a developing country

Abstract A population based comparative study of head injury in Taiwan was conducted from January to December 1993. Taipei City was selected to represent an urban population and Hualien County its rural counterpart. A total of 4955 cases of head injury in Taipei and 1069 cases in Hualien were studied. The head injury incidence rate in Hualien is about two times that of Taipei. Traffic accident related head injuries, especially motorcycle accidents, accounted for a larger percentage of cases in Hualien than in Taipei. In terms of mortality rate, the injuries tended to be more fatal in Hualien. The preliminary data clearly show that there exist major geographical differences of head injury patterns in urban and rural areas in a developing country. Preventative measures, specifically focusing on motorcycle accident related head injury, need to be adopted to deal with this serious problem.

Clinical practice guidelines in severe traumatic brain injury in Taiwan

BACKGROUNDnSevere TBIs are major causes of disability and death in accidents. The Brain Trauma Foundation supported the first edition of the Guidelines for the Management of Severe Traumatic Brain Injury in 1995 and revised it in 2000. The recommendations in these guidelines are well accepted in the world. There are still some different views on trauma mechanisms, pathogenesis, and managements in different areas. Individualized guidelines for different countries would be necessary, and Taiwan is no exception.nnnMETHODSnIn November 2005, we organized the severe TBI guidelines committee and selected 9 topics, including ER treatment, ICP monitoring, CPP, fluid therapy, use of sedatives, nutrition, intracranial hypertension, seizure prophylaxis, and second-tier therapy. We have since searched key questions in these topics on Medline. References are classified into 8 levels of evidence: 1++, 1+, 1-, 2++, 2+, 2-, 3, and 4 based on the criteria of the SIGN.nnnRESULTSnRecommendations are formed and graded as A, B, C, and D. Grade A means that at least one piece of evidence is rated as 1++, whereas grade B means inclusion of studies rated as 2++. Grade C means inclusion of references rated as 2+, and grade D means levels of evidence rated as 3 or 4. Overall, 42 recommendations are formed. Three of these are rated as grade A, 13 as grade B, 21 as grade C, and 5 as grade D.nnnCONCLUSIONSnWe have completed the first evidence-based, clinical practice guidelines for severe TBIs. It is hoped that the guidelines will provide concepts and recommendations to promote the quality of care for severe TBIs in Taiwan.

Combined encephalo-arterio-synangiosis and encephalo-myo-synangiosis in the treatment of Moyamoya disease

From January 1990 to December 1995, a total of nine cases of Moyamoya disease were treated at the National Taiwan University Hospital with combined encephalo-arterio-synangiosis (EAS) and encephalo-myo-synangiosis (EMS). There were five males and four females and their ages ranged from 6 months to 31 years. Of these, two cases had their first symptom as intracranial hemorrhage and the rest of the cases had ischemic manifestations. Surgical treatment with combined EAS and EMS was performed on 16 hemispheres of the nine cases. The superficial temporal artery with its anterior and posterior branches was isolated and fixed to the pial surface. Then, the muscle pedicle from the bivalved temporal muscle was used as a dural graft to cover the artery. All the cases showed good neovascularization on follow-up angiography performed at 2-3 months after surgery. These two patients with hemorrhagic symptoms were followed for 52 and 61 months, respectively. Neither of these two cases showed recurrent bleeding. For patients with ischemic symptoms, the follow-up period ranged from 8 to 73 months (mean 41.7 months). All the patients showed improvement in their clinical symptoms.