부산대학교 도서관

More than 130 million Americans visit emergency departments each year. Between 1996 and 2009, there was a 13-fold increase in documentation of obesity as the principal diagnosis. Fewer than 25% of these patients meet ACSM recommendations for aerobic and resistance exercise, and no more than a third are counseled on exercise behavior. For exercise counselling to become standard practice, we must improve the nature of reporting. PURPOSE: To examine how obesity is documented in a clinical setting and estimate its effect on patient outcomes. METHODS: We conducted a chart review of two patient samples over a 4-year period (2012-2015). Both samples were drawn from a single institution; 768 were treated at the trauma center (TC) and 2,106 were treated at the emergency department (ED). All patients in both samples were between 15 and 85 years of age and had a Glasgow Coma Scale score ≥ 14. We evaluated obesity reporting and the consequences of obesity on patient outcomes using logistic, linear, and negative binomial regressions as appropriate. RESULTS: In both samples, documenting of obesity increased each year (p < 0.001). In the TC group, 3.3% of patients were documented as obese in 2012, 9.4% in 2013, 30.0% in 2014, and 24.3% in 2015. In the ED sample, 1.1% of patients were documented as obese in 2012, 7.0% in 2013, 29.6% in 2014, and 34.0% in 2015. In 2014 and 2015, when reporting was sufficient, obese patients had lower oximetry (p = 0.020), higher heart rate (p = 0.010), higher systolic (p = 0.006) and diastolic (p = 0.027) blood pressure, more myocardial infarctions (p = 0.014), and higher rates of hypertension (p = 0.007) and diabetes (p < 0.001). Controlling or age, sex, and injury severity, patients categorized as obese cost $31k more to the patient (p = 0.005) and $16k more to the hospital (p = 0.002). Holding sex and age constant, the odds of experiencing a myocardial infarction were 3.1-fold higher in obese patients (p = 0.006) and the odds of being diagnosed with diabetes were 3.0-fold higher (p < 0.001). CONCLUSIONS: Obesity is a strong predictor of patient outcomes in both trauma and emergency medicine. These findings delineate the obesity trends in patient samples and emphasize the importance for obesity interventions using information from clinical settings. Physicians are well-positioned to emphasize exercise guidelines to patients. [ABSTRACT FROM AUTHOR]