Neurological Surgery 脳神経外科46巻10号

2018年10月発行

連載 日常診療に役立つ“頭部外傷”のminimum essence

（2）受傷現場と救急外来における成人の急性頭部外傷（traumatic brain injury：TBI）への対応

著者： 安心院康彦¹

所属機関： ¹国際医療福祉大学熱海病院救急部

ページ範囲：P.931 - P.945

Ⅰ．頭部外傷の疫学
　本邦において，外傷患者は年間1,800万人と推計され，うち約160万人（消防庁の平成25年のデータによれば158万人）の外傷患者が救急搬送され，平成23年の患者調査では27万人が救急入院治療を受けている⁸³⁾．頭部外傷（traumatic brain injury：TBI）は，顔面骨骨折を含めると入院患者の約10%を占める⁸³⁾．また，人口動態統計によると，外傷死の原因の48.7%を占める^60,83)．高次脳機能障害を含む後遺症を有する者は，死亡者数の100倍以上にのぼると推計される¹⁰⁾．
　日本外傷データバンクレポート2015（2010-2014）では，TBIの頻度は下肢外傷に次いで多く，Abbreviated Injury Scale（AIS）スコア3以上の重症例は全TBIの76.7%を占める⁸⁴⁾．一方，本邦における軽症TBIの受傷者の正確な人数は明らかではない．米国では毎年約250万人がTBIを受傷し¹⁸⁾，75〜95%は軽症である^61,120)．軽症TBIの原因として，高齢成人では転倒・転落が多く，若者では交通事故が多い．軽症TBIはアメリカンフットボールなどのコンタクトスポーツで発生数が多く⁴²⁾，戦闘でも多い¹²⁷⁾．

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