Impact of Chest Trauma and Overweight on Mortality and Outcome in Severely Injured Patients

Abstract

The morbidity and mortality of severely injured patients are commonly affected by multiple factors. Especially, severe chest trauma has been shown to be a significant factor in considering outcome. Contemporaneously, weight-associated endocrinological, haematological, and metabolic deviations from the norm seem to have an impact on the posttraumatic course. Therefore, the aim of this study was to determine the influence of body weight on severely injured patients by emphasizing chest trauma. A total of 338 severely injured patients were included. Multivariate regression analyses were performed on patients with severe chest trauma (AIS ≥ 3) and patients with minor chest trauma (AIS < 3). The influence of body weight on in-hospital mortality was evaluated. Of all the patients, 70.4% were male, the median age was 52 years (IQR 36–68), the overall Injury Severity Score (ISS) was 24 points (IQR 17–29), and a median BMI of 25.1 points (IQR 23–28) was determined. In general, chest trauma was associated with prolonged ventilation, prolonged ICU treatment, and increased mortality. For overweight patients with severe chest trauma, an independent survival benefit was found (OR 0.158; p = 0.037). Overweight seems to have an impact on the mortality of severely injured patients with combined chest trauma. Potentially, a nutritive advantage or still-unknown immunological aspects in these patients affecting the intensive treatment course could be argued.

The Impact of Body Mass Composition on Outcome in Multiple Traumatized Patients—Results from the Fourth Thoracic and Third Lumbar Vertebrae: A Single-Center Retrospective Observational Study

“…Additionally, the present study revealed that MT patients with high subcutaneous fat tissue were in need of ventilation for a longer period and had a prolonged stay in the ICU and in hospital. These findings are in line with previously published observations on obese trauma patients [ 42 , 43 , 44 ]. As an underlying cause, Covarrubias et al reported on obesity being responsible for decreased chest wall compliance, decreased lung volume, increased oxygen consumption, increased respiratory rate, mild hypoxemia, and increased airway resistance [ 44 ].…”

Characteristics and Clinical Outcomes of Elderly Patients with Trauma Treated in a Local Trauma Center

“…Previous studies have identified these changes, and determined that changes in the cardiovascular and pulmonary systems have the greatest impact on patient's prognosis [14,15]. In this current study the GCS and chest injury were independent risk factors of mortality which is similar to previous studies [9,16].…”

The Impact of Childhood Obesity on Traumatic Injury Outcomes

“…Our ndings are inconsistent with the "armor phenomenon," "cushion effect," "reverse epidemiology," and "obesity paradox," suggesting a potential protective bene t of childhood obesity regarding trauma. Multiple authors describe such a protective effect of obesity in trauma and intensive care [20,21]. For example, pediatric obese patients had the lowest mortality on univariate analysis and were non-inferior to healthy weight controls; the Injury Severity Score (ISS) was lowest in the obese group; and Hospital Length of Stay, ICU Length of Stay, and ventilator days were no different than with healthy weight patients [22].…”