Childhood obesity: a risk factor for injuries observed at a level-1 trauma center

Abstract

Purpose Obesity is an independent risk factor in trauma-related morbidity in adults. The purpose of this study was to investigate the effect of obesity in the pediatric trauma population. Methods All patients (6-20 years) between January 2004 and July 2007 were retrospectively reviewed and defined as non-obese (body mass index [BMI] <95th percentile for age) or obese (BMI ≥95th percentile for age). Groups were compared for differences in demographics, initial vital signs, mechanisms of injury, length of stay, intensive care unit stay, ventilator days, Injury Severity Score, operative procedures, and clinical outcomes. Results Of 1314 patients analyzed, there were 1020 (77%) nonobese patients (mean BMI = 18.8 kg/m2) and 294 (23%) obese patients (mean BMI = 29.7 kg/m2). There was no significant difference in sex, heart rate, length of stay, intensive care unit days, ventilator days, Injury Severity Score, and mortality between the groups. The obese children were significantly younger than the nonobese children (10.9 ± 3.3 vs 11.5 ± 3.5 years; P = .008) and had a higher systolic blood pressure during initial evaluation (128 ± 17 vs 124 ± 16 mm Hg, P < .001). In addition, the obese group had a higher incidence of extremity fractures (55% vs 40%; P < .001) and orthopedic surgical intervention (42% vs 30%; P < .001) but a lower incidence of closed head injury (12% vs 18%; P = .013) and intraabdominal injuries (6% vs 11%; P = .023). Evaluation of complications showed a higher incidence of decubitus ulcers (P = .043) and deep vein thrombosis (P = .008) in the obese group. Conclusion In pediatric trauma patients, obesity may be a risk factor for sustaining an extremity fracture requiring operative intervention and having a higher risk for certain complications (ie, deep venous thrombosis [DVT] and decubitus ulcers) despite having a lower incidence of intracranial and intraabdominal injuries. Results are similar to reports examining the effect(s) of obesity on the adult population.

Childhood Obesity Is Associated With Increased Risk of Most Lower Extremity Fractures

“…By virtue of having access to an extremely large, self-contained electronic database that is truly a crosssection of our southern California population, we were able to provide stable population-based estimates of the associations between childhood obesity and lower extremity fractures that have not previously been demonstrated in such a way. In addition, rather than purely comparing obese (C 95 th percentile) with nonobese patients or assess the association between obesity and all musculoskeletal complaints, like with all previously referenced studies [2,3,14,26,27,[30][31][32]39, 41], we measured more specific weight classes and assessed only lower extremity fractures to understand how varying degrees of increasing (or decreasing) weight affect fracture risk in the lower extremities. Also, we further assessed fracture risk by both age and lower extremity region as opposed to that of all prior studies on the association of childhood or adult obesity and fracture/injury risk (Table 5).…”

Childhood Obesity as a Risk Factor for Lateral Condyle Fractures Over Supracondylar Humerus Fractures

“…Furthermore, the average BMI-percentile-for-age was higher for the LC group and there were more obese patients in the LC cohort compared with the SC cohort. Previous authors, including Rana et al [20] and Leet et al [14], have shown that childhood obesity alone is a risk factor for an increased number of both nonoperative and operative complications. LC fractures are intraarticular physeal injuries with a higher incidence of complications, including problems with nonunion, growth arrest with subsequent malunion, angular deformities, and early arthritis compared with SC humerus fractures, and a high number of LC fractures necessitates open surgical intervention [22].…”

“…Previous studies have demonstrated obese children have an increased risk of sustaining an injury compared with their normal-weight peers (OR 1.51) [9] and increased weight status has been associated with a 1.7 times increased fracture risk [3], particularly for fractures incurred from low-energy mechanisms [3]. Furthermore, when fractures do occur in obese children, they have been associated with a higher prevalence of complications including decubitus ulcers (1% versus 0.2%) [20], deep vein thrombosis (0.7% versus 0%) [20], and other postoperative complications, including refracture, wound infection, and wound dehiscence [14].…”

Impaired bone health and asymptomatic vertebral compressions in fracture-prone children: A case-control study

“…(1,5,6) In children, fractures have been reported to associate with low bone mineral density (BMD) (9,10) and certain lifestyle factors, including low calcium intake, (11) poor vitamin D status, (12) and low as well as high physical activity. (13,14) Overweight children are prone to injuries and fractures, (15,16) while normal body fat content seems to be beneficial for bone health. (17) Until recently, no consensus was available for diagnostic criteria of childhood osteoporosis.…”