Mejias Christopher, Hoegger Mark, Snyder Jason, Raptis Constantine, Mellnick Vincent
Diagnostic Radiology, Washington University in St Louis School of Medicine Mallinckrodt Institute of Radiology, Saint Louis, Missouri, USA.
Department of Surgery, Washington University in St Louis, Saint Louis, Missouri, USA.
Trauma Surg Acute Care Open. 2023 Aug 18;8(1):e001072. doi: 10.1136/tsaco-2022-001072. eCollection 2023.
The effect of obesity in penetrating trauma outcomes is poorly understood. The purpose of this study was to determine if there is a protective effect of subcutaneous or visceral fat from stab and gunshot wounds.
443 patients admitted after penetrating traumatic injury of the torso were retrospectively identified from our institution's trauma registry. CT scans performed at presentation were used to determine cross-sectional area of visceral and subcutaneous fat at the level of the umbilicus via manual segmentation. Obesity-associated parameters including body mass index, visceral and subcutaneous fat were compared with injury severity score, length of hospital/intesive care unit (ICU) stay, and number of operating room (OR) visits. Parameters were compared between patients who sustained stab wounds versus gunshot injuries.
Comparing all patients with gunshot injuries with those with stab injuries, gunshots resulted in increased hospital and ICU length of stay, and injury severity score (ISS). For patients with gunshot wounds, all obesity-related parameters correlated with increased length of stay and total ICU stay; subcutaneous fat and visceral fat were correlated with increased OR visits, but there was no significant correlation between obesity-related parameters and ISS. In contrast, with stab wounds there were no statistically significant associations between obesity parameters and any of the outcome measures.
For penetrating trauma in the torso, obesity is correlated with worse outcomes with gunshot injuries but not in stab injuries.
Level III, prognostic and epidemiological.
肥胖对穿透性创伤结局的影响尚不清楚。本研究的目的是确定皮下或内脏脂肪对刺伤和枪伤是否具有保护作用。
从我们机构的创伤登记处回顾性识别443例躯干穿透性创伤后入院的患者。入院时进行的CT扫描用于通过手动分割确定脐水平的内脏和皮下脂肪横截面积。将包括体重指数、内脏和皮下脂肪在内的肥胖相关参数与损伤严重程度评分、住院/重症监护病房（ICU）住院时间以及手术室（OR）就诊次数进行比较。比较刺伤患者和枪伤患者的参数。
将所有枪伤患者与刺伤患者进行比较，枪伤导致住院和ICU住院时间以及损伤严重程度评分（ISS）增加。对于枪伤患者，所有肥胖相关参数均与住院时间和ICU总住院时间增加相关；皮下脂肪和内脏脂肪与手术室就诊次数增加相关，但肥胖相关参数与ISS之间无显著相关性。相比之下，对于刺伤，肥胖参数与任何结局指标之间均无统计学上的显著关联。
对于躯干穿透性创伤，肥胖与枪伤的较差结局相关，但与刺伤无关。
三级，预后和流行病学。
