Prehosp Emerg Care. 2021 May-Jun;25(3):361-369. doi: 10.1080/10903127.2020.1755754. Epub 2020 May 5.
Stable patients with less severe injuries are not necessarily triaged to high-level trauma centers according to current guidelines. Obese patients are prone to comorbidities and complications. We hypothesized that stable obese patients with low-energy trauma have lower mortality and fewer complications if treated at Level-I/II trauma centers. Blunt abdominal trauma (BAT) patients with systolic blood pressures ≥90mmHg, Glasgow coma scale ≥14, and respiratory rates at 10-29 were derived from the National Trauma Data Bank between 2013-2015. Per current triage guidelines, these patients are not necessarily triaged to high-level trauma centers. The relationship between obesity and mortality of stable BAT patients was analyzed. A subset analysis of patients with injury severity scores (ISS) <16 was performed with propensity score matching (PSM) to evaluate outcomes between Level-I/II and Level-III/IV trauma centers. Outcomes of obese patients were compared between Level-I/II and Level-III/IV trauma centers. Non-obese patients were analyzed as a control group using a similar PSM cohort analysis. 48,043 stable BAT patients in 707 trauma centers were evaluated. Non-survivors had a significantly higher body mass index (BMI) (28.7 vs. 26.9, < 0.001) and higher proportion of obesity (35.6% vs. 26.5%, < 0.001) than survivors. After a PSM (1,502 obese patients: 751 in Level-I/II trauma centers and 751 in Level-III/IV trauma centers), obese patients treated in Level-I/II trauma centers had significantly lower complication rates than obese patients treated in other trauma centers (20.2% vs. 26.6%, standardized difference = 0.151). The complication rate of obese patients treated at Level-I/II trauma centers was 20.6% lower than obese patients treated at other trauma centers. Obesity plays a role in the mortality of stable BAT patients. Obese patients with ISS < 16 have lower complication rates at Level-I/II trauma centers compared to obese patients treated at other trauma centers. Obesity may be a consideration for triaging to Level-I/II trauma centers.
稳定、损伤较轻的患者不一定需要根据现行指南分诊至高水平创伤中心。肥胖患者易合并合并症和并发症。我们假设，低能量创伤的稳定肥胖患者在 I 级/II 级创伤中心治疗时，死亡率较低，并发症较少。2013 年至 2015 年期间，从国家创伤数据库中提取出钝性腹部创伤 (BAT) 患者，其收缩压≥90mmHg、格拉斯哥昏迷评分≥14、呼吸频率 10-29。根据现行分诊指南，这些患者不一定需要分诊至高水平创伤中心。分析肥胖与稳定 BAT 患者死亡率之间的关系。对损伤严重程度评分 (ISS) <16 的患者进行倾向评分匹配 (PSM) 亚组分析，以评估 I 级/II 级和 III 级/IV 级创伤中心之间的结局。比较肥胖患者在 I 级/II 级和 III 级/IV 级创伤中心的结局。使用类似的 PSM 队列分析，将非肥胖患者作为对照组进行分析。评估了 707 个创伤中心的 48043 例稳定 BAT 患者。非幸存者的体重指数 (BMI) 明显较高 (28.7 与 26.9， < 0.001)，肥胖比例也明显较高 (35.6%与 26.5%， < 0.001)。PSM 后 (1502 例肥胖患者：751 例在 I 级/II 级创伤中心，751 例在 III 级/IV 级创伤中心)，I 级/II 级创伤中心治疗的肥胖患者并发症发生率明显低于其他创伤中心治疗的肥胖患者 (20.2%与 26.6%，标准化差值=0.151)。I 级/II 级创伤中心治疗的肥胖患者的并发症发生率比其他创伤中心治疗的肥胖患者低 20.6%。肥胖在稳定 BAT 患者的死亡率中起作用。ISS <16 的肥胖患者在 I 级/II 级创伤中心的并发症发生率低于在其他创伤中心治疗的肥胖患者。肥胖可能是分诊至 I 级/II 级创伤中心的一个考虑因素。
