Beckmann Nicholas M, Cai Chunyan, Spence Susanna C, Prasarn Mark L, Clark West O
Department of Diagnostic and Interventional Imaging, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin Street, 2.130B, Houston, TX, 77030, USA.
Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA.
Emerg Radiol. 2018 Aug;25(4):415-424. doi: 10.1007/s10140-018-1602-2. Epub 2018 Mar 30.
Correlate body mass index (BMI) with incidence and type of cervical spine injury seen on CT in adult patients presenting with blunt trauma.
Retrospective chart review of all adult blunt trauma patients who had a cervical spine CT performed at our level 1 trauma center during an approximately 3-year period.
A statistically significant (p = 0.01) difference in cervical spine injury incidence was present between different BMI groups. Cervical spine injury incidence was 7.7% for underweight (BMI ≤ 18) patients, 7.1% for normal weight (BMI 18-25) patients, 6.2% for overweight/obese (BMI 25-35) patients, and 4.7% for morbidly obese (BMI > 35) patients. Using BMI > 18-25 as a reference group, females with BMI > 25-35 had an adjusted odds ratio (aOR) of 0.56 (CI 0.41-0.75) and females with BMI > 35 had an aOR of 0.42 (CI 0.26-0.70). Males with a BMI ≤ 18 had an aOR of 2.20 (CI 1.12-4.32) and males with BMI > 35 had an aOR of 0.66 (CI 0.46-0.95). A particularly low incidence of cervical spine injury was observed in patients older than 65 in the obese group with a cervical spine injury rate of only 1.4% in this patient population. No statistical significant difference was seen in injury morphology across the BMI groups.
An inverse relationship exists between BMI and the overall incidence of cervical spine injury. This protective effect appears to be influenced by gender with elevated BMI having lower relative odds of cervical spine injury in women than in men. A particularly low rate of cervical spine injury was identified in obese patients over the age of 65. Routine imaging of all elderly, obese trauma patients with low energy mechanism of injury may not be warranted.
将体重指数（BMI）与钝性创伤成年患者CT所见颈椎损伤的发生率及类型进行关联分析。
回顾性查阅在我们的一级创伤中心于约3年期间内接受颈椎CT检查的所有成年钝性创伤患者的病历。
不同BMI组之间颈椎损伤发生率存在统计学显著差异（p = 0.01）。体重过轻（BMI≤18）患者的颈椎损伤发生率为7.7%，正常体重（BMI 18 - 25）患者为7.1%，超重/肥胖（BMI 25 - 35）患者为6.2%，病态肥胖（BMI>35）患者为4.7%。以BMI>18 - 25作为参照组，BMI>25 - 35的女性调整优势比（aOR）为0.56（95%置信区间[CI] 0.41 - 0.75），BMI>35的女性aOR为0.42（CI 0.26 - 0.70）。BMI≤18的男性aOR为2.20（CI 1.12 - 4.32），BMI>35的男性aOR为0.66（CI 0.46 - 0.95）。在肥胖组中，65岁以上患者的颈椎损伤发生率特别低，该人群的颈椎损伤率仅为1.4%。各BMI组之间损伤形态未见统计学显著差异。
BMI与颈椎损伤的总体发生率呈负相关。这种保护作用似乎受性别影响，BMI升高时女性颈椎损伤的相对几率低于男性。65岁以上肥胖患者的颈椎损伤率特别低。对于所有低能量损伤机制的老年肥胖创伤患者，可能无需进行常规影像学检查。
