肥胖对腹部枪伤后结局的影响。
Impact of obesity on outcomes after abdominal gunshot injury.
机构信息
From the Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, CA.
出版信息
J Trauma Acute Care Surg. 2021 Apr 1;90(4):680-684. doi: 10.1097/TA.0000000000003070.
BACKGROUND
The impact of obesity, on outcomes after a gunshot wound, remains unclear. We hypothesized that patients with obesity have a higher burden of intraabdominal injuries after gunshot injury when compared with the nonobese population.
METHODS
The Trauma Quality Improvement Program database (2013-2017) was queried for all patients age ≥16 with abdominal gunshot injuries. Patients who died in the emergency department (ED), arrived without signs of life, had Abbreviated Injury Scale score ≥ 3 in any other region, or transferred from an outside hospital were excluded. The patient with obesity was defined by a body mass index ≥ 30. Demographics, injury data, and outcomes were abstracted and analyzed. Patients with obesity were compared to those with a body mass index < 30. Multivariate logistical regression was used to compare mortality between groups.
RESULTS
Of 34,138 patients with gunshot injuries, there were 2,616 (7.7%) with isolated abdominal injuries. Median age is 29 years (22-39 years), 86.7% men. Eight hundred twenty-seven (31.6%) were obese. The obese group was significantly older (32 [25-42] vs. 27 [22-37]; p < 0.001) with a higher incidence of hypertension (16.8% vs. 6.3%, p < 0.001) and diabetes mellitus (7.1% vs. 2.3%, p < 0.001). There was no difference in presenting vital signs, abdominal Abbreviated Injury Scale or Injury Severity Score between groups. The rate of superficial injuries and intraabdominal organ injuries were comparable between groups. Patients with obesity had significantly higher mortality (6.5% vs. 4.2%, p = 0.010), hospital length of stay (9 [7-16] vs. 9[6-14], p < 0.001), ventilator days (3 [2-5] vs. 3 [2-4], p = 0.015), and hospital-acquired pneumonia (3.5% vs. 1.7%, p = 0.005). On multivariate analysis, in addition to older age (odds ratio [OR], 1.050; p < 0.001), ED hypotension (OR, 3.192; p < 0.001), and ED tachycardia (OR, 3.714; p < 0.001), obesity was significantly associated with mortality (OR, 1.636; p = 0.021).
CONCLUSION
Patients with obesity are at a high risk of mortality after abdominal gunshot injury. Further prospective evaluation is warranted.
LEVEL OF EVIDENCE
Prognostic study, Level III.
背景
肥胖对枪伤后结局的影响尚不清楚。我们假设与非肥胖人群相比，肥胖患者的腹部枪伤后存在更高的腹腔内损伤负担。
方法
检索创伤质量改进计划数据库（2013-2017 年）中所有年龄≥16 岁、有腹部枪伤的患者。排除在急诊科（ED）死亡、无生命迹象到达、任何其他部位损伤严重程度评分（Abbreviated Injury Scale score）≥3 分或从外院转来的患者。肥胖定义为体重指数（body mass index）≥30。提取和分析患者的人口统计学、损伤数据和结局。将肥胖患者与体重指数<30 的患者进行比较。采用多变量逻辑回归比较两组间的死亡率。
结果
在 34138 例有枪伤的患者中，有 2616 例（7.7%）为孤立性腹部损伤。中位年龄 29 岁（22-39 岁），86.7%为男性。827 例（31.6%）为肥胖。肥胖组明显更年长（32[25-42]岁 vs. 27[22-37]岁；p<0.001），高血压（16.8% vs. 6.3%，p<0.001）和糖尿病（7.1% vs. 2.3%，p<0.001）的发生率更高。两组间入院时生命体征、腹部损伤严重程度评分和创伤严重度评分均无差异。两组间的浅表损伤和腹腔内器官损伤发生率相似。肥胖患者的死亡率（6.5% vs. 4.2%，p=0.010）、住院时间（9[7-16] vs. 9[6-14]，p<0.001）、呼吸机使用天数（3[2-5] vs. 3[2-4]，p=0.015）和医院获得性肺炎（3.5% vs. 1.7%，p=0.005）均较高。多变量分析显示，除了年龄较大（优势比[OR]，1.050；p<0.001）、ED 低血压（OR，3.192；p<0.001）和 ED 心动过速（OR，3.714；p<0.001）外，肥胖与死亡率显著相关（OR，1.636；p=0.021）。
结论
肥胖患者腹部枪伤后死亡率高。需要进一步进行前瞻性评估。
证据水平
预后研究，III 级。
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