Brown Carlos V R, Neville Angela L, Salim Ali, Rhee Peter, Cologne Kyle, Demetriades Demetrios
Division of Trauma and Critical Care, Department of Surgery, Los Angeles County/University of Southern California Medical Center, Los Angeles, CA 90033, USA.
J Pediatr Surg. 2006 Jan;41(1):88-91; discussion 88-91. doi: 10.1016/j.jpedsurg.2005.10.012.
PURPOSE/BACKGROUND: In conjunction with the obesity epidemic in adults, we are starting to see an increase of obesity in children and adolescents. Obesity has been identified as risk factor for poor outcomes in adult trauma patients, but has not been investigated adequately in younger patients. The purpose of this study was to investigate the impact of obesity on the outcomes of a severely injured population of children and adolescents.
Retrospective review of traumatized children (age 6-12) and adolescents (age 13-19) admitted to the intensive care unit (ICU) at an urban, level I trauma center from 1998 to 2003. The trauma registry and ICU database were used for data acquisition. Height and weight were recorded for each patient upon admission to the ICU and used to calculate body mass index (BMI). Patients were categorized as either lean (BMI <95th percentile for age) or obese (BMI > or =95th percentile for age). The two groups were compared regarding admission demographics, vital signs, mechanism of injury, patterns of injury, Injury Severity Score, and operations required. Outcomes evaluated were need for and length of mechanical ventilation, complications, length of hospital and ICU stay, and mortality.
There were 316 pediatric and adolescent trauma patients (262 [83%] lean, mean BMI = 23 kg/m2 and 54 [17%] obese, mean BMI = 33 kg/m2) admitted to the ICU. The lean and obese groups were similar regarding age, sex, mechanism of injury, admission vitals, injury severity, and operations required. Injury patterns were similar, except obese patients had less severe head injuries. Although there was no difference in mortality among obese (15%) and non-obese (9%) patients (P = .39), obese children did have more complications (41% vs 22%, P = .04). In addition, obese patients required longer ICU stays (8 +/- 9 vs 6 +/- 6 days, P = .05) after severe trauma.
Despite similar admission characteristics and less severe head injuries, obese children and adolescents have more complications and require longer ICU stays than their lean counterparts.
目的/背景：随着成人肥胖症的流行，我们开始看到儿童和青少年肥胖症也在增加。肥胖已被确定为成年创伤患者预后不良的危险因素，但在较年轻患者中尚未得到充分研究。本研究的目的是调查肥胖对严重受伤的儿童和青少年人群预后的影响。
对1998年至2003年在一家城市一级创伤中心入住重症监护病房（ICU）的受创伤儿童（6至12岁）和青少年（13至19岁）进行回顾性研究。创伤登记册和ICU数据库用于数据收集。每位患者在入住ICU时记录身高和体重，并用于计算体重指数（BMI）。患者分为瘦型（BMI<年龄的第95百分位数）或肥胖型（BMI>或=年龄的第95百分位数）。比较两组患者的入院人口统计学、生命体征、损伤机制、损伤模式、损伤严重程度评分和所需手术情况。评估的预后指标包括机械通气的需求和时长、并发症、住院和ICU住院时长以及死亡率。
共有316名儿科和青少年创伤患者入住ICU（262名[83%]瘦型，平均BMI = 23 kg/m²；54名[17%]肥胖型，平均BMI = 33 kg/m²）。瘦型和肥胖型组在年龄、性别、损伤机制、入院生命体征、损伤严重程度和所需手术方面相似。损伤模式相似，但肥胖患者的头部损伤较轻。尽管肥胖患者（15%）和非肥胖患者（9%）的死亡率无差异（P = 0.39），但肥胖儿童的并发症更多（41%对22%，P = 0.04）。此外，严重创伤后肥胖患者的ICU住院时间更长（8±9天对6±6天，P = 0.05）。
尽管入院特征相似且头部损伤较轻，但肥胖儿童和青少年比瘦型儿童和青少年有更多并发症，且需要更长的ICU住院时间。
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