儿科创伤患者的肥胖悖论。

The Obesity Paradox in the Pediatric Trauma Patient.

机构信息

Rutgers RWJMS, New Brunswick, NJ, USA.

Department of Pediatric Surgery, Rutgers RWJMS, USA.

出版信息

J Pediatr Surg. 2024 Feb;59(2):275-280. doi: 10.1016/j.jpedsurg.2023.10.038. Epub 2023 Oct 21.

DOI:10.1016/j.jpedsurg.2023.10.038

PMID:37993398

Abstract

BACKGROUND

Obesity is a chronic disease that adversely impacts patient outcomes and increasingly affecting the pediatric population. According to the CDC, in 2020 the prevalence of obesity among children and adolescents was estimated to be as high as 19.7%. The obesity paradox is the increased survival for overweight and obese adult trauma patients when compared to patients with healthy weights. The aim of this study was to analyze the impact of BMI and outcomes in the pediatric trauma population.

METHODS

Trauma patients in the 2-18 years age group and reported to the 2017-2019 National Trauma Data Bank were identified. CDC growth charts and z-scores were calculated to categorize patients into four subgroups: underweight (<5th percentile), healthy weight (5th-85th percentile), overweight (85th-95th percentile), and obesity (>95th percentile). Primary outcome studied was the mortality rate. Secondary outcomes included injury severity score (ISS), hospital length of stay (LOS), ICU LOS, and number of days on a ventilator. Continuous and categorical data were analyzed using ANOVA and Chi-squared test, respectively, using the healthy BMI category as reference group. P < 0.05 was considered significant.

RESULTS

A total of 161,458 patients [Underweight: 9148 (6%), Healthy weight: 88,009 (55%), Overweight: 26,740 (17%), and Obese: 37,561 (23%)] were included. The mean age was 11 years (SD:5.1). Total mortality for the patient set was 1825 (1.13%). The lowest mortality rate was in the obese group. The ISS was lowest in the obese group, while ICU LOS and days on ventilator were no different than control patients. Hospital LOS and transfer to rehabilitation rates were higher in the obese population.

CONCLUSION

Obesity appears to have a protective effect on mortality and significantly better secondary outcomes in the pediatric trauma population. Further study is necessary to evaluate the interplay between body weight and outcomes in pediatric trauma and disease states.

LEVEL OF EVIDENCE

III.

摘要

背景

肥胖是一种慢性病，会对患者的预后产生不利影响，且日益影响儿科人群。根据疾病控制与预防中心（CDC）的数据，2020 年，儿童和青少年肥胖的患病率估计高达 19.7%。肥胖悖论是指超重和肥胖的成年创伤患者的存活率高于体重健康的患者。本研究的目的是分析 BMI 和儿科创伤人群结局的影响。

方法

确定了年龄在 2-18 岁之间并报告给 2017-2019 年国家创伤数据库的创伤患者。计算了 CDC 生长图表和 Z 分数，将患者分为四组：体重不足（<第 5 百分位）、健康体重（第 5-85 百分位）、超重（第 85-95 百分位）和肥胖（>第 95 百分位）。主要研究结局是死亡率。次要结局包括伤害严重程度评分（ISS）、住院时间（LOS）、重症监护病房 LOS 和呼吸机使用天数。使用健康 BMI 类别作为参考组，分别使用方差分析和卡方检验分析连续和分类数据。P<0.05 被认为具有统计学意义。

结果

共纳入 161458 例患者[体重不足：9148（6%）、健康体重：88009（55%）、超重：26740（17%）和肥胖：37561（23%）]。患者平均年龄为 11 岁（标准差：5.1）。患者总死亡率为 1825（1.13%）。肥胖组死亡率最低。肥胖组 ISS 最低，而 ICU LOS 和呼吸机使用天数与对照患者无差异。肥胖人群的住院时间和转康复率较高。