Patel Lina, Cowden John D, Dowd Denise, Hampl Sarah, Felich Noreen
Division of Emergency Medicine, Department of Pediatrics, Children's Mercy Hospital and Clinics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri 64108, USA.
J Burn Care Res. 2010 Mar-Apr;31(2):251-6. doi: 10.1097/BCR.0b013e3181d0f549.
Childhood obesity is a major public health problem in the United States and is associated with numerous comorbidities. The relationship of obesity to risk of traumatic injury and recovery has been described, although not in depth. In adults with burns, obesity has been linked to negative impact on functional outcomes as well as increased mortality. Less is known about the impact of obesity on children with burns. The primary objective of this study was to determine the effect of obesity on length of hospital stay (LOS) among admitted pediatric burn patients. A secondary objective was to compare the difference in burn characteristics between obese and nonobese burn patients. To explore these questions, a retrospective cohort study of patients aged 0 to 18 years admitted to a children's hospital burn unit between February 1, 2000, and September 30, 2006 was performed. For the purposes of this study, obesity was defined as weight-for-length (<2 years of age) or body mass index (> or =2 years of age) > or =95th percentile for age and gender. Patients who had concomitant, nonburn injuries were not included in the study. LOS was measured in days, and an initial univariate analysis examined the association of clinical and demographic factors with LOS. To adjust for confounding, those factors that were found to be significantly associated with LOS were entered into a stepwise linear regression. A total of 528 patients were included in the study group, 17.4% of whom were obese. Obese patients were more likely to suffer a burn of a high-risk anatomic area (72.8% vs 60.8%). Median LOS for obese patients was significantly higher than nonobese (9.3 vs 7.1 days, P < .05). In the adjusted model, factors significantly associated with LOS included total body surface area burned, percent full thickness burn, Medicaid insurance status, and obesity. After controlling for these factors, obese children had a 6.5% longer LOS than nonobese children. This interesting finding raises the question of which factors are responsible for the increased length of stay for obese children hospitalized with burns. Investigating factors such as rate of complications, slower healing, or greater functional impairment may shed light on this finding.
儿童肥胖是美国一个主要的公共卫生问题，且与众多合并症相关。肥胖与创伤性损伤风险及恢复之间的关系已有描述，但并不深入。在成年烧伤患者中，肥胖与功能预后的负面影响以及死亡率增加有关。关于肥胖对烧伤儿童的影响，人们了解得较少。本研究的主要目的是确定肥胖对入院儿科烧伤患者住院时间（LOS）的影响。次要目的是比较肥胖和非肥胖烧伤患者烧伤特征的差异。为探究这些问题，对2000年2月1日至2006年9月30日期间入住一家儿童医院烧伤科的0至18岁患者进行了一项回顾性队列研究。在本研究中，肥胖定义为身长体重比（<2岁）或体重指数（≥2岁）高于或等于年龄和性别的第95百分位数。伴有非烧伤性损伤的患者未纳入本研究。住院时间以天为单位进行测量，初步单因素分析检验了临床和人口统计学因素与住院时间的关联。为校正混杂因素，将那些被发现与住院时间显著相关的因素纳入逐步线性回归分析。研究组共纳入528例患者，其中17.4%为肥胖患者。肥胖患者更有可能遭受高风险解剖区域烧伤（72.8%对60.8%）。肥胖患者的中位住院时间显著高于非肥胖患者（9.3天对7.1天，P<.05）。在调整模型中，与住院时间显著相关的因素包括烧伤总面积、全层烧伤百分比、医疗补助保险状态和肥胖。在控制这些因素后，肥胖儿童的住院时间比非肥胖儿童长6.5%。这一有趣的发现引发了一个问题：哪些因素导致了肥胖烧伤住院儿童住院时间的延长。对并发症发生率、愈合较慢或功能障碍较大等因素进行调查可能会揭示这一发现。
