Obesity and increased mortality in blunt trauma

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Choban, Patricia Smith¹; Weireter, Jr, Leonard J.²; Maynes, Carolyn³

Obesity and increased mortality in blunt trauma

J Trauma. September 1991;31(9):1253-1257

©1991 Williams & Wilkins

Affiliations

¹Surgical Clinic, Naval Hospital Jacksonville, Jacksonville, Florida

²Sentara Norfolk General Hospital, Norfolk, Virginia

³Department of Surgery, Eastern Virginia Medical School, Norfolk, Virginia
Abstract

To determine the effect of admission body weight on blunt trauma victims, a chart review of all patients > 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 (< 27 kg/m²), overweight (27-31 kg/m²), and severely overweight (> 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 < 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 < 0.0001). There was an increase in complications, mainly pulmonary problems, in the SO group (p < 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 < 0.007). The severely overweight group was characterized by a rapid deterioration and demise that was unresponsive to intervention. ISS did not differ among nonsurvivors. 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 < 0.04).
Links

DOI: 10.1097/00005373-199109000-00009

PubMed: 1920556

WoS: A1991GH56700010

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2015	Kent RW, Forman J. Restraint system biomechanics. In: Yoganandan N, Nahum AM, Melvin JW, eds. Accidental Injury: Biomechanics and Prevention. 3rd ed. New York: Springer; 2015:113-141.
2001	Moran SG, McGwin G Jr., Reiff DA, Rue LW III. The association between body habitus, restraint use, and fatality in motor vehicle collisions. In: 45th Annual Proceedings, Association for the Advancement of Automotive Medicine (AAAM). September 24-26, 2001; San Antonio, TX.
2003	Wang SC, Bednarski B, Patel S, Yan A, Kohoyda-Inglis C, Kennedy T, Link E, Rowe S, Sochor M, Arbab S. Increased depth of subcutaneous fat is protective against abdominal injuries in motor vehicle collisions. In: 47th Annual Proceedings, Association for the Advancement of Automotive Medicine (AAAM). September 22-24, 2003; Lisbon, Portugal.545-559.
2009	Forman J, Lopez-Valdes FJ, Lessley D, Kindig M, Kent R, Bostrom O. The effect of obesity on the restraint of automobile occupants. In: 53rd Annual Proceedings, Association for the Advancement of Automotive Medicine (AAAM). October 5-7, 2009; Baltimore, MD.25-40.
2011	Yoganandan N, Fitzharris M, Pintar FA, Stemper BD, Rinaldi J, Maiman DJ, Fildes BN. Demographics, velocity distributions, and impact type as predictors of AIS 4+ head injuries in motor vehicle crashes. In: 55th Annual Proceedings, Association for the Advancement of Automotive Medicine (AAAM). October 3-5, 2011; Paris, France.267-280.
2015	Joodaki H, Forman J, Forghani A, Overby B, Kent R, Crandall J, Beahlen B, Beebe M, Bostrom O. Comparison of kinematic behaviour of a first generation obese dummy and obese PMHS in frontal sled tests. In: Proceedings of the 2015 International IRCOBI Conference on the Biomechanics of Injury. September 9-11, 2015; Lyon, France.454-466.
2018	Gepner BD, Joodaki H, Sun Z, Jayathirtha M, Kim T, Forman JL, Kerrigan JR. Performance of the obese GHBMC models in the sled and belt pull test conditions. In: Proceedings of the 2018 International IRCOBI Conference on the Biomechanics of Injury. September 12-14, 2018; Athens, Greece.355-368.
2015	Joodaki H, Forman J, Forghani A, Overby B, Kent R, Crandall J, Beahlen B, Beebe M, Bostrom O. Comparison of kinematic and dynamic behavior of a first generation obese dummy and obese PMHS in frontal sled tests. In: Proceedings of the 11th Ohio State University Injury Biomechanics Symposium. May 17-19, 2015; Columbus, OH.
2012	Yoganandan N, Humm JR, Pintar FA, Brasel KH, Rudd RW, Ridella SA. Thoraco-abdominal deflection responses of post mortem human surrogates in side impacts. Stapp Car Crash J. October 2012;56:49-64.
2002	Mock C, Grossman D, Kaufman R, Mack C, Rivara F. The relationship between body weight and risk of death and serious injury in motor vehicle crashes. Accid Anal Prev. March 2002;34(2):221-228.
2008	Cormier JM. The influence of body mass index on thoracic injuries in frontal impacts. Accid Anal Prev. March 2008;40(2):610-615.
2004	Neville AL, Brown CVR, Weng J, Demetriades D, Velmahos GC. Obesity is an independent risk factor of mortality in severely injured blunt trauma patients. Arch Surg. September 2004;139(9):983-987.
2014	Kim J-E, Kim IH, Shum PC, Shih AM, Pintar F, Shen W, Ma X, Laud PW, Heymsfield SB, Allison DB, Zhu S. A computational study of injury severity and pattern sustained by overweight drivers in frontal motor vehicle crashes. Comput Methods Biomech Biomed Eng. July 2014;17(9):965-977.
2003	Arbabi S, Wahl WL, Hemmila MR, Kohoyda-Inglis C, Taheri PA, Wang SC. The cushion effect. J Trauma. June 2003;54(6):1090-1093.
2010	Kent RW, Forman JL, Bostrom O. Is there really a "cushion effect"? a biomechanical investigation of crash injury mechanisms in the obese. Obesity. 2010;18(4):749-753.
2013	Rupp JD, Flannagan CAC, Leslie AJ, Hoff CN, Reed MP, Cunningham RM. Effects of BMI on the risk and frequency of AIS 3+ injuries in motor‐vehicle crashes. Obesity. January 2013;21(1):E88-E97.