体重指数（BMI）升高与创伤后死亡率升高、预后恶化以及具有高度特异性的损伤模式有关：一项对 191274 例患者的多机构分析。

Increasing BMI is associated with higher mortality, worsening outcomes and highly specific injury patterns following trauma: A multi-institutional analysis of 191,274 patients.

机构信息

From the Center for Trauma and Acute Care Surgery Research, Clinical Operations Group (S.M.F., J.L.M., J.M.G., N.Y.W., Y.S., R.W., D.D.W.), HCA Healthcare, Nashville, Tennessee.

出版信息

J Trauma Acute Care Surg. 2021 Feb 1;90(2):376-383. doi: 10.1097/TA.0000000000003040.

DOI:10.1097/TA.0000000000003040

PMID:33502149

Abstract

BACKGROUND

As the prevalence of obesity has increased, trauma centers are faced with managing this expanding demographics' unique care requirements. Research on the effects of body mass index (BMI) in trauma patients remains conflicting. This study aims to evaluate the impact of BMI on patterns of injury and patient outcomes following trauma.

METHODS

Patients from 87 hospitals' trauma registries were selected. Those missing height, weight, disposition, or who died in the emergency department were excluded. The BMI categories were calculated from admission height and weight and verified against the electronic medical records. Patients were grouped by the National Institutes of Health-defined obesity class and compared by rate of mortality and in-hospital complications. Logistic regression was used to estimate associations, adjusting for age, gender, race, Injury Severity Score, and number of comorbidities.

RESULTS

There were 191,274 patients, 53% male; mean age was 60.4 years, mean Glasgow Coma Scale score 14.4, mean Injury Severity Score of 8.8, and 40.4% normal weight. Increased BMI was associated with an injury pattern of increased rates of extremity fractures (humerus, femur, tibia/fibula) and decreased rates of hip fractures and head injuries. Compared with the normal weight group, patients were more likely to die if they were Underweight (adjusted odds ratio [AOR], 1.18; 95% confidence interval [CI], 1.01-1.38), obese class II (AOR, 1.24; 95% CI, 1.07-1.45), or obese class III (AOR, 1.55; 95% CI, 1.29-1.87). Obese class III was associated with higher odds of a National Trauma Data Standard complication (AOR, 1.20; 95% CI, 1.11-1.30).

CONCLUSION

In this large multicenter study, increasing BMI and lower than normal BMI were strongly associated with higher mortality. Increasing BMI was also associated with longer length of stay, increased complications, and unique injury patterns. These untoward outcomes, coupled with a distinct injury pattern, warrant care guidelines specific to trauma patients with higher BMI, as well as those with BMI lower than normal.

LEVEL OF EVIDENCE

Epidemiological, Level III.

摘要

背景

随着肥胖症的患病率不断上升，创伤中心面临着管理这一不断扩大的人群独特的护理需求。关于身体质量指数（BMI）对创伤患者的影响的研究仍然存在争议。本研究旨在评估 BMI 对创伤后患者的损伤模式和患者结局的影响。

方法

从 87 家医院创伤登记处中选择患者。排除身高、体重、处置或在急诊科死亡缺失的患者。使用入院时的身高和体重计算 BMI 类别，并与电子病历进行核对。患者按照美国国立卫生研究院定义的肥胖类别分组，并通过死亡率和住院并发症进行比较。使用 logistic 回归估计关联，调整年龄、性别、种族、损伤严重程度评分和合并症数量。

结果

共纳入 191274 例患者，其中 53%为男性；平均年龄为 60.4 岁，平均格拉斯哥昏迷评分 14.4，平均损伤严重程度评分为 8.8，40.4%为正常体重。BMI 增加与四肢骨折（肱骨干、股骨干、胫骨/腓骨干）发生率增加、髋部骨折和头部损伤发生率降低的损伤模式有关。与正常体重组相比，如果患者体重过低（调整后的优势比[OR]，1.18；95%置信区间[CI]，1.01-1.38）、肥胖 II 级（OR，1.24；95% CI，1.07-1.45）或肥胖 III 级（OR，1.55；95% CI，1.29-1.87），则患者更有可能死亡。肥胖 III 级与更高的国家创伤数据标准并发症的可能性相关（OR，1.20；95% CI，1.11-1.30）。