台灣地區兒少身體暴力傷害型態之分析

Abstract

研究背景：兒童虐待是全世界重視的健康問題也是重要的法醫學議題，兒童遭受虐待是兒童失能或死亡的重要因素之一。 研究目的: 本研究欲了解台灣地區兒童身體虐待及非兒童虐待暴力案件傷害型態，以幫助法醫師在遇到疑似兒童虐待案件時做鑑別。 研考材料及方法：本研究收集2001-2010年法務部法醫研究所小於18歲他殺死亡案例(分為兒童虐待及非兒童虐待暴力兩組)及2001-2010年台北某醫學中心之小於18歲兒童虐待個案及他人蓄意傷害個案，經由統計學方法比較各組個案之創傷部位、數量、大小和創傷種類。 研究結果：本研究收集兒童虐待解剖110例(男:46人，女:64人，平均年齡2.9歲)，兒童虐待驗傷共119例(男:64人，女:54人，平均年齡8.4歲)，非兒童虐待暴力解剖共42例(男:37人，女:5人，平均年齡16.6歲)，非兒童虐待暴力驗傷共49例(男:42人，女:7人，平均年齡12.9歲)，兒童虐待組以臉部有傷所佔比率最高(61.1%)，其次為下肢(41.9%)及顱腦(40.6%)，非兒童虐待暴力組以臉部有傷比率最高(49.5%)，其次為顱腦(39.6%)及上肢(39.6%)。兒童虐待組，平均創傷數量最多的為臉部(2.47)，其次為下肢(2.03)，傷痕數量顯著高於非兒童虐待暴力組的臉部(1.58，p值:0.027)及下肢(0.63，p值< 0.001)。在兒童虐待組平均瘀傷(5.56)及燒燙傷(0.36)的傷痕數，較非兒童虐待暴力組的平均瘀傷(2.10)及燒燙傷(0.00)數多(p值各為< 0.001及0.006)。兒童虐待致死案例中死亡原因以顱內出血最多(47.2%)，其次為出血性休克(16.9%)，非兒童虐待暴力致死個案亦以顱內出血(39.7%)最多，其次為出血性休克(37.5%)。 結論： 研究結果：兒童虐待個案的臉部創傷及下肢創傷數量明顯比非兒童虐待暴力個案多，兒童虐待組的平均瘀傷及燒燙傷數多於非兒童虐待暴力組。本研究結果可做為法醫師及臨床醫療人員驗傷及辨識兒童虐待之參考。

Background: Child abuse is a worldwide health problem as well as an important forensic issue. Child abuse is a critical factor of child disability and child death. Aims:The goal of this study is to investigate the injury patterns of child abuse cases and non-child abuse cases in Taiwan in order to help the forensic examiners to differenciate the cases of child abuse. Materials and Methodes: The aotopsy reports of cases of child abuse homocides and non-child abuse homocides(< 18 year-old) of Institute of Forensic Medicine, Ministry of Justice from 2001 to 2010 were analyzed.The medical records of cases of child abuse and children with intended wound(< 18 year-old) of a medical center in Taipei were analyzed. The sites, the numbers, the sizes, and the types of the injuries were compared among the different groups of cases. Results: We recruited 110 child abuse autopsy cases (46males, 64 females, average age : 2.9 year-old), 119 child abuse wounded cases(64 males, 54 females, average age 8.4 year-old), 42 non-child abuse autopsy cases (37 males, 5 females, average 16.6 year-old) and 49 non-child abuse wounded cases (42 males, 7 females, average 12.9 year-old). In the child abuse group, and the most common sites of injuries are the face(61.1%), the lower limbs(41.9%) and the cranium(40.6%). In the non-child abuse group, and the most common sites of injuries are the face(49.5%), the cranium(39.6%) and the upper limbs(39.6%). The average numbers of facial injuries (2.47) and the lower limbs injuries(2.03) are among the highest in the child abuse group, and are significantly higher than the average numbers of facial injury(1.58, p=0.027), and lower limbs injury(0.63, p<0.001) in non-child abuse groups. The average numbers of bruises(5.56) and burns(0.36) of the child abuse group are more than the bruise(2.10, p<0.001) and burns(0, p=0.006) of the non-child abuse group. The most common cause of death in the child abuse autopy group is intracramial hemorrhage(47.2%), followed by hemorrhagic shock(16.9%), which is similar to that of the non-child abuse group with 39.7% of intracramial hemorrhage, followed by 37.5% of hemorrhage shock. Conclusions: The average numbers of facial and lower limbs injuries of child abuse cases are more than those of the non-child abuse cases. The average numbers of bruises and burns of the child abuse group are more than of the non-child abuse group. This data will be helpful for forensic examiners and clinic healthcare providers.