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Obese trauma patients are at increased risk of early hypovolemic shock: a retrospective cohort analysis of 1,084 severely injured patients.
Crit Care. 2012 May 08; 16(3):R77.CC

Abstract

INTRODUCTION

Morbid obesity and its consequences are considered risk factors for adverse outcome in trauma, although the pathophysiologic mechanisms are incompletely understood. The aim of this study was to compare initial resuscitation, treatment, and short-term outcome of severely injured patients by body mass index (BMI).

METHODS

A total of 1,084 severely injured patients with an injury severity score of 16 or greater were enrolled between 1996 and 2009 and grouped according to BMI. Their course of treatment and in-hospital outcome were analyzed by univariate and multivariate comparison.

RESULTS

Of these patients, 603 (55.6%) were of normal weight with a BMI between 18.5 and 24.9, 361 (33.3%) had BMI values between 25 and 29.9, and 90 patients (8.3%) were obese (BMI ≥ 30). Thirty patients (2.8%) had BMI levels below 18.5. All groups were comparable with respect to injury severity, initial resuscitation, and time to ICU admission. There was a tendency towards higher mortality in obese patients (mortality 24.4%) and also overweight patients (mortality 18.8%) when compared with patients with a normal BMI (mortality 16.6%). Obese patients showed the highest mortality on day 0 (8.9% vs. 2.8% in the normal-weight group, P = 0.023), mostly due to persistent shock (6.7%). When corrected for BMI, obese patients are provided significantly lower volumes of intravenous fluids during the initial resuscitation period.

CONCLUSION

In contrast to the mostly American literature, only a low percentage of trauma patients at a European trauma center are obese. These patients are at risk of higher mortality from persistent hemorrhagic shock in the initial phase after trauma, which may potentially be related to relative hypovolemia during the resuscitation period. In the later course of treatment, no significant differences exist with respect to specific complications, hospital stay, or in-hospital mortality.

Authors

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Pub Type(s)

Journal Article

Language

eng

PubMed ID

22568946

Citation

Nelson, Jana, et al. "Obese Trauma Patients Are at Increased Risk of Early Hypovolemic Shock: a Retrospective Cohort Analysis of 1,084 Severely Injured Patients." Critical Care (London, England), vol. 16, no. 3, 2012, pp. R77.
Nelson J, Billeter AT, Seifert B, et al. Obese trauma patients are at increased risk of early hypovolemic shock: a retrospective cohort analysis of 1,084 severely injured patients. Crit Care. 2012;16(3):R77.
Nelson, J., Billeter, A. T., Seifert, B., Neuhaus, V., Trentz, O., Hofer, C. K., & Turina, M. (2012). Obese trauma patients are at increased risk of early hypovolemic shock: a retrospective cohort analysis of 1,084 severely injured patients. Critical Care (London, England), 16(3), R77. https://doi.org/10.1186/cc11334
Nelson J, et al. Obese Trauma Patients Are at Increased Risk of Early Hypovolemic Shock: a Retrospective Cohort Analysis of 1,084 Severely Injured Patients. Crit Care. 2012 May 8;16(3):R77. PubMed PMID: 22568946.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Obese trauma patients are at increased risk of early hypovolemic shock: a retrospective cohort analysis of 1,084 severely injured patients. AU - Nelson,Jana, AU - Billeter,Adrian T, AU - Seifert,Burkhardt, AU - Neuhaus,Valentin, AU - Trentz,Otmar, AU - Hofer,Christoph K, AU - Turina,Matthias, Y1 - 2012/05/08/ PY - 2011/12/19/received PY - 2012/05/08/accepted PY - 2012/5/10/entrez PY - 2012/5/10/pubmed PY - 2015/6/24/medline SP - R77 EP - R77 JF - Critical care (London, England) JO - Crit Care VL - 16 IS - 3 N2 - INTRODUCTION: Morbid obesity and its consequences are considered risk factors for adverse outcome in trauma, although the pathophysiologic mechanisms are incompletely understood. The aim of this study was to compare initial resuscitation, treatment, and short-term outcome of severely injured patients by body mass index (BMI). METHODS: A total of 1,084 severely injured patients with an injury severity score of 16 or greater were enrolled between 1996 and 2009 and grouped according to BMI. Their course of treatment and in-hospital outcome were analyzed by univariate and multivariate comparison. RESULTS: Of these patients, 603 (55.6%) were of normal weight with a BMI between 18.5 and 24.9, 361 (33.3%) had BMI values between 25 and 29.9, and 90 patients (8.3%) were obese (BMI ≥ 30). Thirty patients (2.8%) had BMI levels below 18.5. All groups were comparable with respect to injury severity, initial resuscitation, and time to ICU admission. There was a tendency towards higher mortality in obese patients (mortality 24.4%) and also overweight patients (mortality 18.8%) when compared with patients with a normal BMI (mortality 16.6%). Obese patients showed the highest mortality on day 0 (8.9% vs. 2.8% in the normal-weight group, P = 0.023), mostly due to persistent shock (6.7%). When corrected for BMI, obese patients are provided significantly lower volumes of intravenous fluids during the initial resuscitation period. CONCLUSION: In contrast to the mostly American literature, only a low percentage of trauma patients at a European trauma center are obese. These patients are at risk of higher mortality from persistent hemorrhagic shock in the initial phase after trauma, which may potentially be related to relative hypovolemia during the resuscitation period. In the later course of treatment, no significant differences exist with respect to specific complications, hospital stay, or in-hospital mortality. SN - 1466-609X UR - https://www.unboundmedicine.com/medline/citation/22568946/Obese_trauma_patients_are_at_increased_risk_of_early_hypovolemic_shock:_a_retrospective_cohort_analysis_of_1084_severely_injured_patients_ L2 - https://ccforum.biomedcentral.com/articles/10.1186/cc11334 DB - PRIME DP - Unbound Medicine ER -