J. O. Hwabejire1, B. Adesibikan1, T. A. Oyetunji2, O. Omole1, C. E. Nembhard1, M. Williams1, E. E. Cornwell III1, W. R. Greene3 1Howard University College Of Medicine,Surgery,Washington, DC, USA 2Children’s Mercy Hospital- University Of Missouri Kansas City,Surgery,Kansas City, MO, USA 3Emory University School Of Medicine,Atlanta, GA, USA
Introduction: We have previously demonstrated that extremes of body mass index (BMI) are associated with poor outcomes following blunt traumatic hemorrhagic shock. In this study, we examined the risk factors for mortality in underweight patients following blunt trauma.
Methods: The Glue Grant database was retrospectively analyzed. Patients with BMI <18.5 kg/m2 who met criteria for hemorrhagic shock after blunt trauma were included. Survivors were compared to non-survivors using univariate analysis. Multivariable analysis was used to determine predictors of mortality.
Results: There were 102 patients who met criteria for inclusion in the study. Their mean age was 46 years (SD=20), with 62% being males, 89% Whites and 5% black. Mortality in this cohort was 52.9%, compared to 16.0 % in all comers and 14.3 % in patients with a normal BMI. Amongst the underweight, there was no differences in age, multiple organ dysfunction score, or emergency room (ER) shock index or pre-injury comorbidities between survivors and non-survivors. Compared to survivors, non-survivors were hypotensive in the ER (systolic BP: 110 ±27 vs. 87±38 mmHg, p=0.001), had higher ER lactate (7.1 ±4.1 vs. 4.1 ±2.5 mg/dL, p<0.001), were more coagulopathic (ER INR: 1.92 ±1.91 vs. 1.24±0.30, p=0.026 ), had higher APACHE II score (35±6 vs. 28±7, p<0.001), higher injury severity score, ISS (35±13 vs. 27±11, p=0.002), received more crystalloids (12696±6550 vs. 9796±4964 mL, p=0.014), and more blood (6070±4912 vs. 2240±3658 mL, p<0.001) within 12 hours of presentation. When only patients with ISS >25 were compared, non-survivors were still more likely to be hypotensive (ER SBP: 112 ±28 vs. 87±36 mmHg, p=0.004), acidotic (ER lactate: 7.4 ±4.4 vs. 4.4 ±3.0 mg/dL, p=0.006), received more blood 6174±4926 vs. 3024±4612 mL, p=0.011) and had a higher APACHE II score (35±6 vs. 29±5, p<0.001). In the multivariate analysis, after adjusting for ISS, the only independent predictor of mortality was the APACHE II score (OR: 1.35, CI 1.08-1.1.69, p=0.009).
Conclusion: The Acute Physiologic and Chronic Health Evaluation (APACHE) II score independently predicts mortality in the underweight after blunt traumatic hemorrhagic shock. Underweight patients appear to lack the physiologic reserve to tolerate severe trauma.