A. Lichter1, F. Speranza1, W. Rebekah1, P. Parikh1, R. Markert1, G. Semon1 1Wright State University,Dayton, OH, USA
Introduction: Obesity has been on the rise in recent decades and has created a significant burden on health care. Obesity plays significant role in presentation and management of trauma patients, including management of pneumonia in polytrauma patients. However, role of obesity has not been evaluated for chest trauma patients with rib fractures. This study, aims to determine its impact and management of patients who sustain rib fractures as a result of a traumatic incident.
Methods: This study was approved by Wright State University’s IRB. All adult trauma patients who sustained blunt chest wall trauma causing rib fractures and were presented at our Level 1 Trauma Center from 2013-2014. were included in the study. All the patients who survived less than 48 hours, had penetrating injuries to the chest, or had a concomitant head injury were excluded. Obesity was defined as a body mass index (BMI) of ≥30. Both obese and non-obese groups were compared using Pearson Chi-Square test for categorical variables and Man-Whitney U Test for continuous variables. We compared both these groups after adjusting for Injury Severity Score (ISS) using logistics regression when the assumptions for this test are met.
Results: 213 patients met the inclusion criteria with an average 3.6 ribs fracture. Consistent with the national average, 64 (30.6%) were obese. Both obese and non-obese groups of patients did not differ in age (61.6 vs. 59.9, p=0.89). Obese patients had higher ISS (17.0 vs 13.9, p=0.05), and significantly higher ventilator days (2.1 vs. 1.2, p=0.003), ICU Length of Stay (LOS) (3.3 vs. 1.9, p=0.004), and total hospital LOS (9.6 vs. 6.0, p=0.019) than non-obese group, however, the mortality was not significantly different (p=0.37). Since ISS was higher in obese group, we controlled for ISS and determined that the obese patients were more likely to require mechanical ventilation both before and after controlling for ISS (34.4% vs. 16.1%, p=0.003).
Conclusion: Rib fractures remain an important focus in obese patients admitted to trauma centers since they are at increased risk for requiring mechanical ventilation and has worse outcomes, although overall mortality is not affected. Rib fracture protocols that focus on increased pain control, aggressive pulmonary toilet regimens and possible early surgical intervention need to be further investigated specifically in obese patients to decrease the associated morbidity and improve outcomes.