Outcomes From a Level 1 Trauma and Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program Center of Excellence

Anderson, Tiffany; Williams, Eric M; Loftus, Tyler J.; Johnson-Mann, Crystal; Taylor, Jessica E.

doi:10.1177/00031348221084091

Cited by 1 publication

(1 citation statement)

References 2 publications

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“…A higher body mass index (BMI) has been associated with a lower mortality 5,6 and injury severity score (ISS) 3 for adult blunt trauma patients, and a recent meta-analysis by Chen et al, concluded that an armor phenomenon may exist for adolescents with obesity that sustain thoracoabdominal stab injuries, but this may not lead to improved outcomes. 4 In fact, some studies have found that patients with obesity have a longer length of stay (LOS) in the intensive care unit (ICU) after trauma 7 and obesity is an independent risk factor for complications such as nosocomial infections, 8 prolonged mechanical ventilation, and postoperative pulmonary complications. 9 However, studies in the adolescent population evaluating the effect of obesity on injury after penetrating trauma are limited.…”

Section: Introductionmentioning

confidence: 99%

Relationship of Obesity and Severe Penetrating Thoracic and Abdominal Injuries in Adolescent Patients

Alvarez

Grigorian

Swentek

et al. 2023

The American Surgeon™

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Background Over 20% of United States adolescents are obese. A thicker layer of subcutaneous adiposity might provide a protective “armor” layer against penetrating wounds. We hypothesized that adolescents with obesity presenting after isolated thoracic and abdominal penetrating trauma have lower rates of severe injury and mortality than adolescents without obesity. Methods The 2017-2019 Trauma Quality Improvement Program database was queried for patients between 12 and 17 years old presenting with knife or gunshot wounds. Patients with body mass index (BMI) ≥30 (obese) were compared to patients with BMI <30. Sub-analyses were performed for adolescents with isolated abdominal trauma and isolated thoracic trauma. Severe injury was defined as an abbreviated injury scale grade >3. Bivariate analyses were performed. Results 12,181 patients were identified; 1603 (13.2%) had obesity. In isolated abdominal gunshot or knife wounds, rates of severe intra-abdominal injuries and mortality were similar (all P > .05) between groups. In isolated thoracic gunshot wounds, adolescents with obesity had a lower rate of severe thoracic injury (5.1% vs 13.4%, P = .005) but statistically similar mortality (2.2% vs 6.3%, P = .053) compared to adolescents without obesity. In isolated thoracic knife wounds, rates of severe thoracic injuries and mortality were similar (all P > .05) between groups. Discussion Adolescent trauma patients with and without obesity presenting after isolated abdominal or thoracic knife wounds had similar rates of severe injury, operative intervention, and mortality. However, adolescents with obesity presenting after an isolated thoracic gunshot wound had a lower rate of severe injury. This may impact the future work-up and management of adolescents sustaining isolated thoracic gunshot wounds.

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