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

Mark A. Newell, Michael R. Bard, Claudia E. Goettler, Eric A. Toschlog, Paul J. Schenarts, Scott G. Sagraves, Don Holbert, Walter J. Pories, Michael F. Rotondo

Research output: Contribution to journalArticle

98 Citations (Scopus)

Abstract

Background: The influence of increased body mass index (BMI) on morbidity and mortality in critically injured trauma patients has been studied, with conflicting results. The objective of this study was to investigate the relationship between stratified BMI and outcomes in blunt injured patients. Study Design: Consecutive adult trauma patients from July 2001 to November 2005 with Injury Severity Score (ISS) ≥ 16 and blunt mechanism were evaluated using the National Trauma Registry of the American College of Surgeons. Demographics, injury severity, hospital course, complications, and mortality were compared among standard BMI strata. Logistic regression was used to determine odds ratios (OR) with 95% confidence intervals and evaluate BMI as an independent risk factor for morbidity and mortality. Statistical significance was set at p < 0.05. Results: The study group consisted of 1,543 patients. Controlling for age, gender, Injury Severity Score, and Revised Trauma Score, and using BMI 18.5 to 24.9 kg/m2 as the reference category, morbid obesity (BMI ≥ 40 kg/m2) was associated with acute respiratory distress syndrome (OR 3.675, 95% CI, 1.237 to 10.916), acute respiratory failure (OR 2.793, 95% CI, 1.633 to 4.778), acute renal failure (OR 13.506, 2.388 to 76.385), multisystem organ failure (OR 2.639, 95% CI, 1.085 to 6.421), pneumonia (OR 2.487, 95% CI, 1.483 to 4.302), urinary tract infection (OR 2.332, 95% CI, 1.229 to 4.427), deep venous thrombosis (OR 4.112, 95% CI, 1.253 to 13.496), and decubitus ulcer (OR 2.841, 95% CI, 1.382 to 5.841). Morbid obesity was not associated with increased mortality (OR 0.810, 95% CI, 0.353 to 1.856). Conclusions: This is the largest study to date evaluating the relationship between BMI and outcomes in critically injured trauma patients. Increasing BMI increases morbidity while having no proved influence on mortality.

Original languageEnglish (US)
Pages (from-to)1056-1061
Number of pages6
JournalJournal of the American College of Surgeons
Volume204
Issue number5
DOIs
StatePublished - May 1 2007

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Body Mass Index
Odds Ratio
Wounds and Injuries
Mortality
Injury Severity Score
Morbid Obesity
Morbidity
Pressure Ulcer
Adult Respiratory Distress Syndrome
Acute Kidney Injury
Urinary Tract Infections
Venous Thrombosis
Respiratory Insufficiency
Registries
Pneumonia
Logistic Models
Demography
Confidence Intervals

ASJC Scopus subject areas

  • Surgery

Cite this

Body Mass Index and Outcomes in Critically Injured Blunt Trauma Patients : Weighing the Impact. / Newell, Mark A.; Bard, Michael R.; Goettler, Claudia E.; Toschlog, Eric A.; Schenarts, Paul J.; Sagraves, Scott G.; Holbert, Don; Pories, Walter J.; Rotondo, Michael F.

In: Journal of the American College of Surgeons, Vol. 204, No. 5, 01.05.2007, p. 1056-1061.

Research output: Contribution to journalArticle

Newell, MA, Bard, MR, Goettler, CE, Toschlog, EA, Schenarts, PJ, Sagraves, SG, Holbert, D, Pories, WJ & Rotondo, MF 2007, 'Body Mass Index and Outcomes in Critically Injured Blunt Trauma Patients: Weighing the Impact', Journal of the American College of Surgeons, vol. 204, no. 5, pp. 1056-1061. https://doi.org/10.1016/j.jamcollsurg.2006.12.042
Newell, Mark A. ; Bard, Michael R. ; Goettler, Claudia E. ; Toschlog, Eric A. ; Schenarts, Paul J. ; Sagraves, Scott G. ; Holbert, Don ; Pories, Walter J. ; Rotondo, Michael F. / Body Mass Index and Outcomes in Critically Injured Blunt Trauma Patients : Weighing the Impact. In: Journal of the American College of Surgeons. 2007 ; Vol. 204, No. 5. pp. 1056-1061.
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abstract = "Background: The influence of increased body mass index (BMI) on morbidity and mortality in critically injured trauma patients has been studied, with conflicting results. The objective of this study was to investigate the relationship between stratified BMI and outcomes in blunt injured patients. Study Design: Consecutive adult trauma patients from July 2001 to November 2005 with Injury Severity Score (ISS) ≥ 16 and blunt mechanism were evaluated using the National Trauma Registry of the American College of Surgeons. Demographics, injury severity, hospital course, complications, and mortality were compared among standard BMI strata. Logistic regression was used to determine odds ratios (OR) with 95{\%} confidence intervals and evaluate BMI as an independent risk factor for morbidity and mortality. Statistical significance was set at p < 0.05. Results: The study group consisted of 1,543 patients. Controlling for age, gender, Injury Severity Score, and Revised Trauma Score, and using BMI 18.5 to 24.9 kg/m2 as the reference category, morbid obesity (BMI ≥ 40 kg/m2) was associated with acute respiratory distress syndrome (OR 3.675, 95{\%} CI, 1.237 to 10.916), acute respiratory failure (OR 2.793, 95{\%} CI, 1.633 to 4.778), acute renal failure (OR 13.506, 2.388 to 76.385), multisystem organ failure (OR 2.639, 95{\%} CI, 1.085 to 6.421), pneumonia (OR 2.487, 95{\%} CI, 1.483 to 4.302), urinary tract infection (OR 2.332, 95{\%} CI, 1.229 to 4.427), deep venous thrombosis (OR 4.112, 95{\%} CI, 1.253 to 13.496), and decubitus ulcer (OR 2.841, 95{\%} CI, 1.382 to 5.841). Morbid obesity was not associated with increased mortality (OR 0.810, 95{\%} CI, 0.353 to 1.856). Conclusions: This is the largest study to date evaluating the relationship between BMI and outcomes in critically injured trauma patients. Increasing BMI increases morbidity while having no proved influence on mortality.",
author = "Newell, {Mark A.} and Bard, {Michael R.} and Goettler, {Claudia E.} and Toschlog, {Eric A.} and Schenarts, {Paul J.} and Sagraves, {Scott G.} and Don Holbert and Pories, {Walter J.} and Rotondo, {Michael F.}",
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T2 - Weighing the Impact

AU - Newell, Mark A.

AU - Bard, Michael R.

AU - Goettler, Claudia E.

AU - Toschlog, Eric A.

AU - Schenarts, Paul J.

AU - Sagraves, Scott G.

AU - Holbert, Don

AU - Pories, Walter J.

AU - Rotondo, Michael F.

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N2 - Background: The influence of increased body mass index (BMI) on morbidity and mortality in critically injured trauma patients has been studied, with conflicting results. The objective of this study was to investigate the relationship between stratified BMI and outcomes in blunt injured patients. Study Design: Consecutive adult trauma patients from July 2001 to November 2005 with Injury Severity Score (ISS) ≥ 16 and blunt mechanism were evaluated using the National Trauma Registry of the American College of Surgeons. Demographics, injury severity, hospital course, complications, and mortality were compared among standard BMI strata. Logistic regression was used to determine odds ratios (OR) with 95% confidence intervals and evaluate BMI as an independent risk factor for morbidity and mortality. Statistical significance was set at p < 0.05. Results: The study group consisted of 1,543 patients. Controlling for age, gender, Injury Severity Score, and Revised Trauma Score, and using BMI 18.5 to 24.9 kg/m2 as the reference category, morbid obesity (BMI ≥ 40 kg/m2) was associated with acute respiratory distress syndrome (OR 3.675, 95% CI, 1.237 to 10.916), acute respiratory failure (OR 2.793, 95% CI, 1.633 to 4.778), acute renal failure (OR 13.506, 2.388 to 76.385), multisystem organ failure (OR 2.639, 95% CI, 1.085 to 6.421), pneumonia (OR 2.487, 95% CI, 1.483 to 4.302), urinary tract infection (OR 2.332, 95% CI, 1.229 to 4.427), deep venous thrombosis (OR 4.112, 95% CI, 1.253 to 13.496), and decubitus ulcer (OR 2.841, 95% CI, 1.382 to 5.841). Morbid obesity was not associated with increased mortality (OR 0.810, 95% CI, 0.353 to 1.856). Conclusions: This is the largest study to date evaluating the relationship between BMI and outcomes in critically injured trauma patients. Increasing BMI increases morbidity while having no proved influence on mortality.

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