Association of Injury Factors, Not Body Mass Index, With Hospital Resource Usage in Trauma Patients

Abstract

Background Allocating resources appropriately requires knowing whether obese patients use more resources during a hospital stay than nonobese patients. Objectives To determine if trauma patients with different body mass indexes differed in use of resources measured as a multifaceted outcome variable. Methods A trauma registry was used for a retrospective study of adult patients admitted to a midwestern level I trauma center. Patients were stratified into 3 groups: nonobese (normal weight, overweight), obese, and morbidly obese. Three canonical correlation analyses were used to determine the relationship between patient/injury characteristics and hospital resource usage. Results In a sample of 9771 patients, 71.2% were non-obese, 23.8% obese, and 5.0% morbidly obese. For patient/injury characteristics, Injury Severity Score and physiological complications were significant variables for all 3 groups. Scores on the Glasgow Coma Scale were significant for nonobese patients only. For resource usage, intensive care unit length of stay and procedures were significant variables for all 3 groups. Conclusions Associations between body mass index and outcomes have been noted when assessed as independent variables. However, when resource usage was assessed as a multifaceted outcome variable, injury factors (higher Injury Severity Score, lower scores on the Glasgow Coma Scale, more physiological complications) were associated with resource usage (increased length of stay in the intensive care unit and increased number of procedures). These findings provide clinicians a new perspective for evaluating the complex relationship between patient/injury characteristics and hospital resource usage.

Factors influencing the use of health services by trauma patients according to insurance type and injury severity score in South Korea: Based on Andersen’s behavioral model

“…Total cost of care increased with increasing ISS, which was consistent with the findings of Garnett and Browne [11], and Kuwabara et al [30]. This again confirmed that the ISS enables the prediction of necessary resources for trauma patient management [9] and is a major predictor of healthcare utilization in trauma patients [9,[11][12][13]. Therefore, analysis and interpretation based on the ISS is expected to produce more reliable results pertaining to trauma patients' healthcare utilization, particularly the total cost of care.…”

“…Apart from its use in assessing injury severity in trauma patients, the ISS is an anatomical scoring system effective in predicting mortality, hospital stay, length of recovery, and demands for resources to manage trauma patients [10]. Moreover, it is a major predictor of healthcare utilization in such patients [11][12][13] and is actively utilized in healthcare providers' communications and triage [9]. Therefore, analyzing healthcare utilization in trauma patients according to the ISS is a systematic method of analysis, where trauma patients' healthcare service needs are relatively homogeneously divided.…”