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Obesity May Require a Higher Level of Trauma Care: A Propensity-Matched Nationwide Cohort Study
Insights
Stable obese patients with blunt abdominal trauma (BAT) have fewer complications when treated at Level-I/II trauma centers. Current guidelines may not adequately consider obesity for trauma triage, impacting patient outcomes.
Area of Science:
- Trauma Surgery
- Surgical Outcomes
- Public Health
Background:
- Current trauma triage guidelines may not prioritize stable patients with less severe injuries for high-level trauma centers.
- Obesity is associated with increased comorbidities and potential complications in trauma patients.
- The impact of trauma center level on outcomes for stable, obese patients with blunt abdominal trauma (BAT) requires further investigation.
Purpose of the Study:
- To test the hypothesis that stable obese patients with low-energy trauma experience lower mortality and fewer complications at Level-I/II trauma centers.
- To analyze the relationship between obesity and mortality in stable BAT patients.
- To compare outcomes for obese patients treated at different trauma center levels using propensity score matching (PSM).
Main Methods:
- Retrospective analysis of 48,043 stable BAT patients from the National Trauma Data Bank (2013-2015).
- Inclusion criteria: systolic blood pressure ≥90mmHg, Glasgow Coma Scale ≥14, respiratory rate 10-29.
- Propensity score matching (PSM) was used to compare outcomes between Level-I/II and Level-III/IV trauma centers for obese patients with Injury Severity Score (ISS) <16.
Main Results:
- Non-survivors had a significantly higher body mass index (BMI) and proportion of obesity compared to survivors.
- After PSM, obese patients treated at Level-I/II trauma centers showed significantly lower complication rates (20.2%) compared to those at Level-III/IV centers (26.6%).
- Obese patients treated at Level-I/II trauma centers had a 20.6% lower complication rate than those treated at other trauma centers.
Conclusions:
- Obesity is a significant factor influencing mortality and complications in stable blunt abdominal trauma patients.
- Stable obese patients with an Injury Severity Score (ISS) <16 benefit from treatment at Level-I/II trauma centers, experiencing fewer complications.
- Obesity should be considered as a criterion for triaging patients to higher-level trauma centers.
Objective:
Stable patients with less severe injuries are not necessarily triaged to high-level trauma centers according to current guidelines. Obese patients are prone to comorbidities and complications. We hypothesized that stable obese patients with low-energy trauma have lower mortality and fewer complications if treated at Level-I/II trauma centers. Methods: Blunt abdominal trauma (BAT) patients with systolic blood pressures ≥90mmHg, Glasgow coma scale ≥14, and respiratory rates at 10-29 were derived from the National Trauma Data Bank between 2013-2015. Per current triage guidelines, these patients are not necessarily triaged to high-level trauma centers. The relationship between obesity and mortality of stable BAT patients was analyzed. A subset analysis of patients with injury severity scores (ISS) <16 was performed with propensity score matching (PSM) to evaluate outcomes between Level-I/II and Level-III/IV trauma centers. Outcomes of obese patients were compared between Level-I/II and Level-III/IV trauma centers. Non-obese patients were analyzed as a control group using a similar PSM cohort analysis. Results: 48,043 stable BAT patients in 707 trauma centers were evaluated. Non-survivors had a significantly higher body mass index (BMI) (28.7 vs. 26.9, p < 0.001) and higher proportion of obesity (35.6% vs. 26.5%, p < 0.001) than survivors. After a PSM (1,502 obese patients: 751 in Level-I/II trauma centers and 751 in Level-III/IV trauma centers), obese patients treated in Level-I/II trauma centers had significantly lower complication rates than obese patients treated in other trauma centers (20.2% vs. 26.6%, standardized difference = 0.151). The complication rate of obese patients treated at Level-I/II trauma centers was 20.6% lower than obese patients treated at other trauma centers. Conclusion: Obesity plays a role in the mortality of stable BAT patients. Obese patients with ISS < 16 have lower complication rates at Level-I/II trauma centers compared to obese patients treated at other trauma centers. Obesity may be a consideration for triaging to Level-I/II trauma centers.
