Obesity May Require a Higher Level of Trauma Care: A Propensity-Matched Nationwide Cohort Study

Chih Yuan Fu, Francesco Bajani, Marissa Bokhari, Caroline Butler, Frederick Starr, Thomas Messer, Matthew Kaminsky, Leah C. Tatebe, Andrew Dennis, Victoria Schlanser, Stathis Poulakidas, Chi Tung Cheng, Rubinder Toor, Justin Mis, Faran Bokhari*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Objective: Stable patients with less severe injuries are not necessarily triaged to high-level trauma centers according to current guidelines. Obese patients are prone to comorbidities and complications. We hypothesized that stable obese patients with low-energy trauma have lower mortality and fewer complications if treated at Level-I/II trauma centers. Methods: Blunt abdominal trauma (BAT) patients with systolic blood pressures ≥90mmHg, Glasgow coma scale ≥14, and respiratory rates at 10-29 were derived from the National Trauma Data Bank between 2013-2015. Per current triage guidelines, these patients are not necessarily triaged to high-level trauma centers. The relationship between obesity and mortality of stable BAT patients was analyzed. A subset analysis of patients with injury severity scores (ISS) <16 was performed with propensity score matching (PSM) to evaluate outcomes between Level-I/II and Level-III/IV trauma centers. Outcomes of obese patients were compared between Level-I/II and Level-III/IV trauma centers. Non-obese patients were analyzed as a control group using a similar PSM cohort analysis. Results: 48,043 stable BAT patients in 707 trauma centers were evaluated. Non-survivors had a significantly higher body mass index (BMI) (28.7 vs. 26.9, p < 0.001) and higher proportion of obesity (35.6% vs. 26.5%, p < 0.001) than survivors. After a PSM (1,502 obese patients: 751 in Level-I/II trauma centers and 751 in Level-III/IV trauma centers), obese patients treated in Level-I/II trauma centers had significantly lower complication rates than obese patients treated in other trauma centers (20.2% vs. 26.6%, standardized difference = 0.151). The complication rate of obese patients treated at Level-I/II trauma centers was 20.6% lower than obese patients treated at other trauma centers. Conclusion: Obesity plays a role in the mortality of stable BAT patients. Obese patients with ISS < 16 have lower complication rates at Level-I/II trauma centers compared to obese patients treated at other trauma centers. Obesity may be a consideration for triaging to Level-I/II trauma centers.

Original languageEnglish (US)
Pages (from-to)361-369
Number of pages9
JournalPrehospital Emergency Care
Volume25
Issue number3
DOIs
StatePublished - 2021

Keywords

  • Level-I/II trauma center
  • obesity
  • trauma
  • triage

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency

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