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Obesity and increased mortality in blunt trauma
P S Choban1, L J Weireter, C Maynes
1Surgical Clinic, Naval Hospital, Jacksonville, Florida.
Insights
Severely overweight blunt trauma patients face significantly higher mortality rates. Admission Body Mass Index (BMI) and Injury Severity Score (ISS) independently predict outcomes in trauma victims.
Area of Science:
- Trauma Surgery
- Critical Care Medicine
- Public Health & Epidemiology
Background:
- Admission body weight is a potential factor influencing outcomes in blunt trauma patients.
- Understanding the impact of Body Mass Index (BMI) on trauma outcomes is crucial for clinical management.
Purpose of the Study:
- To investigate the effect of admission body weight, categorized by BMI, on blunt trauma victims.
- To identify predictors of outcome, including BMI and Injury Severity Score (ISS), in trauma patients.
Main Methods:
- Retrospective chart review of 184 blunt trauma patients over 12 years old admitted to Sentara Norfolk General Hospital.
- Calculation of BMI and analysis of demographic data, injuries, ISS, ventilator days (VD), complications, length of stay (LOS), and outcome.
- Groupings based on BMI: average (<27 kg/m2), overweight (27-31 kg/m2), and severely overweight (>31 kg/m2).
Main Results:
- Severely overweight patients exhibited a significantly higher mortality rate (42.1%) compared to average (5.0%) and overweight (8.0%) groups (p < 0.0001).
- BMI and ISS were identified as independent determinants of outcome (p < 0.0001).
- Increased pulmonary complications were observed in the severely overweight group (p < 0.05). Nonsurvivors in the average BMI group had a longer LOS (26.6 days).
Conclusions:
- Admission BMI is a critical factor in blunt trauma outcomes, with severe overweight correlating to increased mortality.
- BMI and ISS are independent predictors of outcome in blunt trauma patients.
- Clinical interventions may be less effective in severely overweight trauma patients who experience rapid deterioration.
Abstract:
To determine the effect of admission body weight on blunt trauma victims, a chart review of all patients greater than 12 years of age admitted to Sentara Norfolk General Hospital between January 1 and July 31, 1987 was undertaken. The charts of 351 patients were reviewed; 184 records contained admission height and weight. These 184 patients made up the study group and age, gender, injuries, Injury Severity Score (ISS), ventilator days (VD), complications, length of stay (LOS), and outcome were noted. Body Mass Index (BMI) (weight (kg)/(height(m))2, was calculated for each patient. The average ISS was 21.87 (range, 1-66) and the average BMI was 25.15 kg/m2 (range, 16-46 kg/m2). The overall mortality for the population was 9%. The population was grouped according to BMI: average (less than 27 kg/m2), overweight (27-31 kg/m2), and severely overweight (greater than 31 kg/m2). The mortality of 5.0% and 8.0% in the average and overweight groups was not different. The severely overweight group had a higher mortality at 42.1% compared with the other two groups (p less than 0.0001). The groups did not differ in age, ISS, LOS, nor VD. Age, BMI, and ISS were subjected to regression analysis. By this method BMI and ISS were independent determinants of outcome (p less than 0.0001). There was an increase in complications, mainly pulmonary problems, in the SO group (p less than 0.05). The three groups were subdivided into survivors and nonsurvivors. The nonsurvivors had a longer average LOS at 26.6 days compared with nonsurvivors in the overweight (5.0 days) or severely overweight (8.62 days) groups (p less than 0.007). The severely group was characterized by a rapid deterioration and demise that was unresponsive to intervention. ISS did not differ among nonsuvivors. Among survivors the severely overweight group had a lower ISS, 9.73. This was different from the overweight group (21.57) and from the average group (20.21) (p less than 0.04).