Rana Ankur R, Michalsky Marc P, Teich Steven, Groner Jonathon I, Caniano Donna A, Schuster Dara P
Division of Pediatric Surgery, Department of Surgery, The Ohio State University College of Medicine and Nationwide Children's Hospital, Columbus, OH 43205, USA.
J Pediatr Surg. 2009 Aug;44(8):1601-5. doi: 10.1016/j.jpedsurg.2008.11.060.
Obesity is an independent risk factor in trauma-related morbidity in adults. The purpose of this study was to investigate the effect of obesity in the pediatric trauma population.
All patients (6-20 years) between January 2004 and July 2007 were retrospectively reviewed and defined as non-obese (body mass index [BMI] <95th percentile for age) or obese (BMI > or =95th percentile for age). Groups were compared for differences in demographics, initial vital signs, mechanisms of injury, length of stay, intensive care unit stay, ventilator days, Injury Severity Score, operative procedures, and clinical outcomes.
Of 1314 patients analyzed, there were 1020 (77%) nonobese patients (mean BMI = 18.8 kg/m(2)) and 294 (23%) obese patients (mean BMI = 29.7 kg/m(2)). There was no significant difference in sex, heart rate, length of stay, intensive care unit days, ventilator days, Injury Severity Score, and mortality between the groups. The obese children were significantly younger than the nonobese children (10.9 +/- 3.3 vs 11.5 +/- 3.5 years; P = .008) and had a higher systolic blood pressure during initial evaluation (128 +/- 17 vs 124 +/- 16 mm Hg, P < .001). In addition, the obese group had a higher incidence of extremity fractures (55% vs 40%; P < .001) and orthopedic surgical intervention (42% vs 30%; P < .001) but a lower incidence of closed head injury (12% vs 18%; P = .013) and intraabdominal injuries (6% vs 11%; P = .023). Evaluation of complications showed a higher incidence of decubitus ulcers (P = .043) and deep vein thrombosis (P = .008) in the obese group.
In pediatric trauma patients, obesity may be a risk factor for sustaining an extremity fracture requiring operative intervention and having a higher risk for certain complications (ie, deep venous thrombosis [DVT] and decubitus ulcers) despite having a lower incidence of intracranial and intraabdominal injuries. Results are similar to reports examining the effect(s) of obesity on the adult population.
肥胖是成人创伤相关发病率的独立危险因素。本研究旨在调查肥胖对儿童创伤人群的影响。
回顾性分析2004年1月至2007年7月期间所有6至20岁的患者，并将其定义为非肥胖（体重指数[BMI]<年龄对应的第95百分位数）或肥胖（BMI≥年龄对应的第95百分位数）。比较两组在人口统计学、初始生命体征、损伤机制、住院时间、重症监护病房住院时间、呼吸机使用天数、损伤严重程度评分、手术操作和临床结局方面的差异。
在分析的1314例患者中，有1020例（77%）非肥胖患者（平均BMI = 18.8 kg/m²）和294例（23%）肥胖患者（平均BMI = 29.7 kg/m²）。两组在性别、心率、住院时间、重症监护病房天数、呼吸机使用天数、损伤严重程度评分和死亡率方面无显著差异。肥胖儿童明显比非肥胖儿童年轻（10.9±3.3岁对11.5±3.5岁；P = 0.008），且在初始评估时收缩压较高（128±17对124±16 mmHg，P < 0.001）。此外，肥胖组四肢骨折的发生率较高（55%对40%；P < 0.001）和骨科手术干预的发生率较高（42%对30%；P < 0.001），但闭合性颅脑损伤的发生率较低（12%对18%；P = 0.013）和腹腔内损伤的发生率较低（6%对11%；P = 0.023）。并发症评估显示肥胖组褥疮（P = 0.043）和深静脉血栓形成（P = 0.008）的发生率较高。
在儿童创伤患者中，肥胖可能是导致需要手术干预的四肢骨折的危险因素，并且尽管颅内和腹腔内损伤的发生率较低，但发生某些并发症（如深静脉血栓形成[DVT]和褥疮）的风险较高。结果与研究肥胖对成人人群影响的报告相似。
