R. Barry1, M. Modarresi1, R. Duran1, E. Thompson1, J. Sanabria1 1Marshall University Schoool Of Medicine,Department Of Surgery,Huntington, WV, USA
Introduction:
Trauma injuries still accounts for 10% of the deaths in the Western World. This mortality rate is believed to be even higher in older patients and subjects with multiple comorbidities. Due to the epidemic of obesity, trauma injuries are more common in obese patients. Obesity has been shown to be a factor for sub-optimal outcomes in adult patients, nonetheless, the impact of obesity in patients who undergo blunt injuries in the elderly still remains to be determined.
Methods:
The incidence, prevalence and mortality rates of blunt trauma by age, sex, cause, BMI, year, and geography were found using datasets from i) the Global Burden of Disease (GBD) group, where the epidemiological data obtained were modelled in DisMod-MR 2.1, a Bayesian meta-regression tool which pools data-points from different sources and adjusts for known sources of variability and ii) the local level II trauma registry where data was modelled by JMP methods. GBD data was extracted from 284 country-year and 976 subnational-year combinations from 27 countries in North America, Latin America, Europe, and New Zealand from 1990 to 2015. Outpatient encounter data was also available from the USA, Norway, Sweden, and Canada for 48 country-years. MU dataset was interrogated in patients ≥65yo admitted with blunt trauma between January 2014 and December 2016. Additional variables on patients who met inclusion criteria (n=1256) included vital signs at admission, exact mechanism of injury (MOI), Injury severity scores (ISS), major medical comorbidities, and length-of-stay (LOS). Variables were compared between obese (BMI≥30 kg/m2) and non-obese (BMI<30 kg/m2).
Results:
There was an increased change in the rate of blunt trauma from falls from 1990 to 2015 of 78.3%, 54.7% and 42.7% at a global, national and state level, respectively. It correlates with an increased change in the mortality rate of 5.7%, 102.6% and 89.3% at a global, national and state level, respectively. The local cohort showed no difference in the mortality of obese vs non-obese patients (n=320 and 4.8% vs n=926 and 4.4%, respectively, p<0.05). The hospital LOS, Glasgow Coma Scale (GCS) score and systolic blood pressure on presentation were similar (4.13 vs 4.03days, 14.61 vs 14.46, and 146 vs 146mmHg for obese vs non-obese patients respectively, p<0.05). In addition, no differences were observed when the ISS was further subdivided based on severity and compared between the two groups. Major medical comorbidities were identified in 280 (87.5%) and 783 (84.6%) patients in the obese and non-obese groups, respectively.
Conclusion:
Although blunt trauma due to falls had increased in elderly patients with obesity, there was no difference in mortality when obese patients were compared to non-obese patients. This may be due to the similar rate of comorbidities between these groups.