Obese trauma patients are at increased risk of early hypovolemic shock: a retrospective cohort analysis of 1084 severely injured patients
Critical Care, 05/09/2012
Nelson J et al. – In contrast to the mostly American literature, only a low percentage of trauma patients at a European trauma center are obese. These patients are at risk of higher mortality from persistent hemorrhagic shock in the initial phase after trauma, which may potentially be related to relative hypovolemia during the resuscitation period. In the later course of treatment, no significant differences exist with respect to specific complications, hospital stay, or in–hospital mortality.Methods
- 1084 severely injured patients with an injury severity score of 16 or greater were enrolled between 1996 and 2009 and grouped according to BMI.
- Their course of treatment and in-hospital outcome were analyzed by univariate and multivariate comparison.
- 603 patients (55.6%) were of normal weight with a BMI between 18.5 and 24.9 BMI, 361 (33.3%) had BMI values between 25 and 29.9, and 90 patients (8.3%) were obese (BMI[greater than or equal to]30).
- 30 patients (2.8%) had BMI levels below 18.5.
- All groups were comparable with respect to injury severity, initial resuscitation, and time to ICU admission.
- There was a tendency towards higher mortality in obese (mortality 24.4%) and also overweight patients (18.8%) when compared to patients with a normal BMI (16.6%).
- Obese patients showed the highest mortality on day 0 (8.9% versus 2.8% in the normal weight group, P=0.023), mostly due to persistent shock (6.7%).
- When corrected for BMI, obese patients are provided significantly lower volumes of iv-fluids during the initial resuscitation period.