title: Body mass index and outcomes in critically injured blunt trauma patients: weighing the impact.
abstract: BACKGROUND
  The influence of increased body mass index (BMI) on morbidity and mortality in critically injured trauma patients has been studied, with conflicting results. The objective of this study was to investigate the relationship between stratified BMI and outcomes in blunt injured patients.
  
  
  METHODS
  Consecutive adult trauma patients from July 2001 to November 2005 with Injury Severity Score (ISS) > or = 16 and blunt mechanism were evaluated using the National Trauma Registry of the American College of Surgeons. Demographics, injury severity, hospital course, complications, and mortality were compared among standard BMI strata. Logistic regression was used to determine odds ratios (OR) with 95% confidence intervals and evaluate BMI as an independent risk factor for morbidity and mortality. Statistical significance was set at p < 0.05.
  
  
  RESULTS
  The study group consisted of 1,543 patients. Controlling for age, gender, Injury Severity Score, and Revised Trauma Score, and using BMI 18.5 to 24.9 kg/m(2) as the reference category, morbid obesity (BMI> or =40 kg/m(2)) was associated with acute respiratory distress syndrome (OR 3.675, 95% CI, 1.237 to 10.916), acute respiratory failure (OR 2.793, 95% CI, 1.633 to 4.778), acute renal failure (OR 13.506, 2.388 to 76.385), multisystem organ failure (OR 2.639, 95% CI, 1.085 to 6.421), pneumonia (OR 2.487, 95% CI, 1.483 to 4.302), urinary tract infection (OR 2.332, 95% CI, 1.229 to 4.427), deep venous thrombosis (OR 4.112, 95% CI, 1.253 to 13.496), and decubitus ulcer (OR 2.841, 95% CI, 1.382 to 5.841). Morbid obesity was not associated with increased mortality (OR 0.810, 95% CI, 0.353 to 1.856).
  
  
  CONCLUSIONS
  This is the largest study to date evaluating the relationship between BMI and outcomes in critically injured trauma patients. Increasing BMI increases morbidity while having no proved influence on mortality.
authors.affiliation: Department of Surgery, The Brody School of Medicine, East Carolina University, Center of Excellence for Trauma and Surgical Critical Care, University Health Systems of Eastern North Carolina, Greenville, NC 27858-4354, USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Newell
authors.forename: Michael R
authors.initials: MR
authors.lastname: Bard
authors.forename: Claudia E
authors.initials: CE
authors.lastname: Goettler
authors.forename: Eric A
authors.initials: EA
authors.lastname: Toschlog
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Schenarts
authors.forename: Scott G
authors.initials: SG
authors.lastname: Sagraves
authors.forename: Don
authors.initials: D
authors.lastname: Holbert
authors.forename: Walter J
authors.initials: WJ
authors.lastname: Pories
authors.forename: Michael F
authors.initials: MF
authors.lastname: Rotondo
mesh_terms: D000328:Adult; D015992:Body Mass Index; D016009:Chi-Square Distribution; D016638:Critical Illness; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000150:complications* / Q000401:mortality