Obesity in Trauma Patients: Correlations of Body Mass Index with Outcomes, Injury Patterns, and Complications

Current understanding of the effects of obesity on trauma patients is incomplete. We hypothesized that among older trauma patients, obese patients differ from nonobese patients in injury patterns, complications, and mortality. Patients older than 45 years old presenting to a Level I trauma center were included in this retrospective database analysis (n = 461). Body mass index (BMI) groups were defined as underweight less than 18.5 kg/m2, normal 18.5 to 24.9 kg/m2, overweight 25.0 to 29.9 kg/m2, or obese greater than 30 kg/m2. Injury patterns, complications, and outcomes were analyzed using univariate analyses, multivariate logistic regression, and Kaplan-Meier survival analysis. Higher BMI is associated with a higher incidence of torso injury and proximal upper extremity injuries in blunt trauma (n = 410). All other injury patterns and complications (except anemia) were similar between BMI groups. The underweight (BMI less than 18.5 kg/m2) group had significantly lower 90-day survival than other groups ( P < 0.05). BMI is not a predictor of morbidity or mortality in multivariate analysis. Among older blunt trauma patients, increasing BMI is associated with higher rates of torso and proximal upper extremity injuries. Our study suggests that obesity is not an independent risk factor for complications or mortality after trauma in older patients. Conversely, underweight trauma patients had a lower 90-day survival.

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Body Mass Index and Outcomes in Critically Injured Blunt Trauma Patients: Weighing the Impact

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2006.12.042 ◽

2007 ◽

Vol 204 (5) ◽

pp. 1056-1061 ◽

Cited By ~ 99

Author(s):

Mark A. Newell ◽

Michael R. Bard ◽

Claudia E. Goettler ◽

Eric A. Toschlog ◽

Paul J. Schenarts ◽

...

Keyword(s):

Body Mass Index ◽

Blunt Trauma ◽

Body Mass ◽

Trauma Patients ◽

The Impact

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Incidence and Risk Factors of Upper Extremity Injuries in Young Adult Men: A Nationwide Registry-Based Study of 128,714 Conscripts

Military Medicine ◽

10.1093/milmed/usz340 ◽

2019 ◽

Vol 185 (3-4) ◽

pp. e487-e494

Author(s):

Harri Pihlajamäki ◽

Arttu Silvennoinen ◽

Paavo-Ilari Kuikka ◽

Tiina Luukkaala ◽

Heikki Kröger ◽

...

Keyword(s):

Risk Factors ◽

Body Mass Index ◽

Incidence Rate ◽

Upper Extremity ◽

Body Mass ◽

Shoulder Joint ◽

Military Service ◽

Young Men ◽

Joint Dislocation ◽

Extremity Injuries

Abstract Introduction Injuries are the major cause of morbidity and loss of active training days in military populations. Previous investigations have mainly focused on lower extremities. This study evaluated the incidence, diagnosis, and risk factors of upper extremity injuries requiring hospitalization in a large cohort of Finnish conscripts during a 5-year period. Materials and Methods A total of 128,714 male military conscripts, who served 6–12 months in compulsory military service, were studied. Injury hospitalization data were obtained from the National Hospital Discharge Register. The main outcome variables were hospitalization due to any injuries to the upper extremity and hospitalization due to traumatic shoulder dislocation. Background variables for risk factor analysis included length of military service, age, body height and weight, body mass index, and physical fitness. Results Overall person-based incidence rate for hospitalization due to upper extremity injury was 743 (95% confidence interval [CI]: 697–791) per 100,000 conscripts per year. Shoulder joint dislocation was the most common injury: incidence rate of 103 (95% CI: 86–122) per 100,000 conscripts per year. Trend during follow-up years 1998–2002 was decreasing concerning on any upper extremity injuries (odd ratios [OR] 0.90; 95% CI: 0.86–0.95, P < 0.001). Body mass index > 25 increased a risk for any injuries of the upper extremity (OR 1.29; CI 95%: 1.10–1.51) and, especially, for shoulder joint dislocation (OR 1.88; CI 95%: 1.26–2.80). Conclusions Overweight young men were at greater risk for upper extremity injuries. The incidence rate of traumatic shoulder joint dislocation was considerably higher than reported previously. In conclusion, preventive measures such as reducing the body weight of overweight young men should play an important role in reducing the incidence of upper extremity injuries.

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Body mass index in blunt trauma patients with hemorrhagic shock: opposite ends of the body mass index spectrum portend poor outcome

The American Journal of Surgery ◽

10.1016/j.amjsurg.2014.12.016 ◽

2015 ◽

Vol 209 (4) ◽

pp. 659-665 ◽

Cited By ~ 4

Author(s):

John O. Hwabejire ◽

Christine E. Nembhard ◽

Augustine C. Obirieze ◽

Tolulope A. Oyetunji ◽

Daniel D. Tran ◽

...

Keyword(s):

Body Mass Index ◽

Hemorrhagic Shock ◽

Blunt Trauma ◽

Body Mass ◽

The Body ◽

Trauma Patients ◽

Poor Outcome

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Body Mass Index and Outcomes in Critically Injured Blunt Trauma Patients: Weighing the Impact

Yearbook of Surgery ◽

10.1016/s0090-3671(08)79164-x ◽

2008 ◽

Vol 2008 ◽

pp. 36

Author(s):

D.W. Mozingo

Keyword(s):

Body Mass Index ◽

Blunt Trauma ◽

Body Mass ◽

Trauma Patients ◽

The Impact

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Norepinephrine Dosing in Obese and Nonobese Patients With Septic Shock

American Journal of Critical Care ◽

10.4037/ajcc2016667 ◽

2016 ◽

Vol 25 (1) ◽

pp. 27-32 ◽

Cited By ~ 10

Author(s):

John J. Radosevich ◽

Asad E. Patanwala ◽

Brian L. Erstad

Keyword(s):

Body Mass Index ◽

Septic Shock ◽

Mean Arterial Pressure ◽

Arterial Pressure ◽

Body Mass ◽

Secondary Outcome ◽

Obese Patients ◽

Hemodynamic Status ◽

Norepinephrine Infusion ◽

Nonobese Patients

Background Whether or not norepinephrine infusions for support of hemodynamic status in patients with septic shock should be weight based is unknown. This situation is particularly pertinent in patients who are extremely overweight or obese. Objective To compare dosing requirements and effect of norepinephrine on blood pressure in obese and nonobese patients with septic shock. Methods In a retrospective cohort study, data on adult patients with septic shock who received norepinephrine infusion for support of hemodynamic status in a tertiary care, academic medical center were analyzed. Patients were categorized as obese (body mass index ≥ 30) or nonobese (body mass index < 30). The primary outcome was dosing requirements of norepinephrine at 60 minutes after the start of the infusion. The secondary outcome was the log-transformed ratio of mean arterial pressure to norepinephrine. Results The final cohort consisted of 100 obese and 100 nonobese patients. Mean norepinephrine infusion rate at 60 minutes was 0.09 (SD, 0.08) μg/kg per minute in the obese group and 0.13 (SD, 0.14) μg/kg per minute in the nonobese group (P = .006). The non–weight-based dose at 60 minutes was 9 μg/min in obese patients and 8 μg/min in nonobese patients (P = .72). The log transformed mean arterial pressure to norepinephrine ratio at 60 minutes was 2.5 (SD, 0.9) in obese patients and 2.5 (SD, 0.8) in nonobese patients (P = .54) Conclusions Compared with nonobese patients, obese patients with septic shock require lower weight-based doses of norepinephrine and similar total norepinephrine doses.

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Results and risk factors for recurrence following single-level tubular lumbar microdiscectomy

Journal of Neurosurgery Spine ◽

10.3171/2009.12.spine08843 ◽

2010 ◽

Vol 12 (6) ◽

pp. 680-686 ◽

Cited By ~ 32

Author(s):

Jennifer A. Moliterno ◽

Jared Knopman ◽

Karishma Parikh ◽

Jessica N. Cohan ◽

Q. Daisy Huang ◽

...

Keyword(s):

Risk Factors ◽

Body Mass Index ◽

Body Mass ◽

Disc Herniation ◽

Lumbar Disc ◽

Lower Body ◽

Single Level ◽

Lower Body Mass Index ◽

Lumbar Microdiscectomy ◽

Nonobese Patients

Object The use of minimally invasive surgical techniques, including microscope-assisted tubular lumbar microdiscectomy (tLMD), has gained increasing popularity in treating lumbar disc herniations (LDHs). This particular procedure has been shown to be both cost-efficient and effective, resulting in outcomes comparable to those of open surgical procedures. Lumbar disc herniation recurrence necessitating reoperation, however, remains an issue following spinal surgery, with an overall reported incidence of approximately 3–13%. The authors' aim in the present study was to report their experience using tLMD for single-level LDH, hoping to provide further insight into the rate of surgical recurrence and to identify potential risk factors leading to this complication. Methods The authors retrospectively reviewed the cases of 217 patients who underwent tLMD for single-level LDH performed identically by 2 surgeons (J.B., R.H.) between 2004 and 2008. Evaluation for LDH recurrence included detailed medical chart review and telephone interview. Recurrent LDH was defined as the return of preoperative signs and symptoms after an interval of postoperative resolution, in conjunction with radiographic demonstration of ipsilateral disc herniation at the same level and pathological confirmation of disc material. A cohort of patients without recurrence was used for comparison to identify possible risk factors for recurrent LDH. Results Of the 147 patients for whom the authors were able to definitively assess symptomatic recurrence status, 14 patients (9.5%) experienced LDH recurrence following single-level tLMD. The most common level involved was L5–S1 (42.9%) and the mean length of time to recurrence was 12 weeks (range 1.5–52 weeks). Sixty-four percent of the patients were male. In a comparison with patients without recurrence, the authors found that relatively lower body mass index was significantly associated with recurrence (p = 0.005), such that LDH in nonobese patients was more likely to recur. Conclusions Recurrence rates following tLMD for LDH compare favorably with those in patients who have undergone open discectomy, lending further support for its effectiveness in treating single-level LDH. Nonobese patients with a relatively lower body mass index, in particular, appear to be at greater risk for recurrence.

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Association of Scapular Fractures and Blunt Thoracic Aortic Injury: Fact or Fiction?

The American Surgeon ◽

10.1177/000313480507100110 ◽

2005 ◽

Vol 71 (1) ◽

pp. 54-57 ◽

Cited By ~ 2

Author(s):

Carlos V.R. Brown ◽

George Velmahos ◽

Dennis Wang ◽

Susan Kennedy ◽

Demetrios Demetriades ◽

...

Keyword(s):

Los Angeles ◽

Blunt Trauma ◽

Medical Center ◽

Aortic Injury ◽

Trauma Patients ◽

Associated Injuries ◽

Blunt Thoracic Aortic Injury ◽

Scapular Fractures ◽

Thoracic Aortic Injury ◽

Level I

It is classically taught that scapular fractures (SF) are commonly associated with blunt thoracic aortic injury (BTAI). The purpose of this study was to determine the association between SF and BTAI. A 10-year retrospective review of blunt trauma admissions from two level I trauma centers located in different geographic regions, Washington Hospital Center (WHC) and Los Angeles County Medical Center and the University of Southern California (LAC/USC), was performed. Patients with SF and BTAI were identified, and records were reviewed to determine associated injuries. We identified 35,541 blunt trauma admissions (WHC: 12,971, LAC/USC: 22,570). SF and BTAI occurred in 1.1 per cent and 0.6 per cent of patients, respectively. Most of the patients with SF had associated injuries (99%). Only four patients with SF had BTAI (4/392; 1.0%). The most common injuries associated with SF were rib (43%), lower extremity (36%), and upper extremity (33%) fractures. SF is uncommon after blunt trauma. Patients with SF almost always have significant associated injuries. Although SF indicates a high amount of energy transmitted to the upper thorax, these patients rarely have BTAI. SF should not be used as an indicator of possible BTAI.

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Injury Patterns by Body Mass Index in US High School Athletes

Journal of Physical Activity and Health ◽

10.1123/jpah.8.2.182 ◽

2011 ◽

Vol 8 (2) ◽

pp. 182-191 ◽

Cited By ~ 30

Author(s):

Ellen Yard ◽

Dawn Comstock

Keyword(s):

High School ◽

Body Mass Index ◽

Body Mass ◽

Knee Injuries ◽

Sports Injury ◽

Normal Weight ◽

Overweight And Obesity ◽

High School Athletes ◽

Injury Patterns ◽

Nationally Representative

Background:There are over 7 million US high school athletes and one-third are overweight or obese. Our objective was to examine injury patterns by body mass index (BMI) in high school athletes.Methods:Certified athletic trainers (ATCs) at 100 nationally representative US high schools submitted exposure and injury information during the 2005 to 08 school years via High School RIO (Reporting Information Online). We retrospectively categorized injured athletes as underweight (≤15th percentile), normal weight (15th−85th percentile), overweight (85th−95th percentile), or obese (≥95th percentile).Results:ATCs reported 13,881 injuries during 5,627,921 athlete-exposures (2.47 injuries per 1000 athlete-exposures). Nearly two-thirds (61.4%) of injured high school athletes were normal weight. The prevalence of overweight and obesity was highest among injured football athletes (54.4%). Compared with normal weight athletes, obese athletes sustained a larger proportion of knee injuries (Injury Proportion Ratio [IPR] = 1.27, 95% CI: 1.14 to 1.42) and their injuries were more likely to have resulted from contact with another person (IPR = 1.31, 95% CI: 1.26 to 1.37). Compared with normal weight athletes, underweight athletes sustained a larger proportion of fractures (IPR = 1.45, 95% CI: 1.10 to 1.92) and a larger proportion of injuries resulting from illegal activity (IPR = 1.59, 95% CI: 1.03 to 2.46).Conclusions:Injury patterns differ by BMI. BMI-targeted preventive interventions should be developed to help decrease sports injury rates.

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Influence of a Stay-At-Home Order on Trauma Volume and Injury Patterns at a Level I Trauma Center in Ohio

The American Surgeon ◽

10.1177/00031348211047488 ◽

2021 ◽

pp. 000313482110474

Author(s):

Gregory S. Huang ◽

Elisha A. Chance ◽

C. Michael Dunham

Keyword(s):

Trauma Center ◽

Drug Testing ◽

Injury Severity ◽

Census Data ◽

Retrospective Chart Review ◽

Trauma Patients ◽

Injury Patterns ◽

Trauma Service ◽

Level I ◽

At Home

Background Changes in injury patterns during the COVID pandemic have been reported in other states. The objective was to explore changes to trauma service volume and admission characteristics at a trauma center in northeast Ohio during a stay-at-home order (SAHO) and compare the 2020 data to historic trauma census data. Methods Retrospective chart review of adult trauma patients admitted to a level I trauma center in northeast Ohio. Trauma admissions from January 21 to July 21, 2020 (COVID period) were compared to date-matched cohorts of trauma admissions from 2018 to 2019 (historic period). The COVID period was further categorized as pre-SAHO, active-SAHO, and post-SAHO. Results The SAHO was associated with a reduction in trauma center admissions that increased after the SAHO ( P = .0033). Only outdoor recreational vehicle (ORV) injuries ( P = .0221) and self-inflicted hanging ( P = .0028) mechanisms were increased during the COVID period and had substantial effect sizes. Glasgow Coma Scores were lower during the COVID period ( P = .0286) with a negligible effect size. Violence-related injuries, injury severity, mortality, and admission characteristics including alcohol and drug testing and positivity were similar in the COVID and historic periods. Discussion The SAHO resulted in a temporary decrease in trauma center admissions. Although ORV and hanging mechanisms were increased, other mechanisms such as alcohol and toxicology proportions, injury severity, length of stay, and mortality were unchanged.

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