Body mass index in blunt trauma patients with hemorrhagic shock: opposite ends of the body mass index spectrum portend poor outcome.
BACKGROUND
There are controversial data on the relationship between trauma and body mass index. We investigated this relationship in traumatic hemorrhagic shock.


METHODS
The "Glue Grant" database was analyzed, stratifying patients into underweight, normal weight (NW), overweight, Class I obesity, Class II obesity, and Class III obesity. Predictors of mortality and surgical interventions were statistically determined.


RESULTS
One thousand nine hundred seventy-six patients were included with no difference in injury severity between groups. Marshall's score was elevated in overweight (5.3 ± 2.7, P = .016), Class I obesity (5.8 ± 2.7, P < .001), Class II obesity (5.9 ± 2.8, P < .001), and Class III obesity (6.3 ± 3.0, P < .001) compared with NW (4.8 ± 2.6). Underweight had higher lactate (4.8 ± 4.2 vs 3.3 ± 2.5, P = .04), were 4 times more likely to die (odds ratio 3.87, confidence interval 2.22 to 6.72), and were more likely to undergo a laparotomy (odds ratio 2.06, confidence interval 1.31 to 3.26) than NW.


CONCLUSIONS
Early assessment of body mass index, with active management of complications in each class, may reduce mortality in traumatic hemorrhagic shock.
Department of Surgery, Howard University College of Medicine and Howard University Hospital, 2041 Georgia Avenue NW, Washington, DC 20060, USA.
John O
JO
Hwabejire
Department of Surgery, Howard University College of Medicine and Howard University Hospital, 2041 Georgia Avenue NW, Washington, DC 20060, USA.
Christine E
CE
Nembhard
Department of Surgery, Howard University College of Medicine and Howard University Hospital, 2041 Georgia Avenue NW, Washington, DC 20060, USA.
Augustine C
AC
Obirieze
Department of Surgery, Howard University College of Medicine and Howard University Hospital, 2041 Georgia Avenue NW, Washington, DC 20060, USA.
Tolulope A
TA
Oyetunji
Department of Surgery, Howard University College of Medicine and Howard University Hospital, 2041 Georgia Avenue NW, Washington, DC 20060, USA.
Daniel D
DD
Tran
Department of Surgery, Howard University College of Medicine and Howard University Hospital, 2041 Georgia Avenue NW, Washington, DC 20060, USA.
Terrence M
TM
Fullum
Department of Surgery, Howard University College of Medicine and Howard University Hospital, 2041 Georgia Avenue NW, Washington, DC 20060, USA.
Suryanarayana M
SM
Siram
Department of Surgery, Howard University College of Medicine and Howard University Hospital, 2041 Georgia Avenue NW, Washington, DC 20060, USA.
Edward E
EE
Cornwell
Department of Surgery, Howard University College of Medicine and Howard University Hospital, 2041 Georgia Avenue NW, Washington, DC 20060, USA. Electronic address: wgreene@howard.edu.
Wendy R
WR
Greene
D000328:Adult; D015992:Body Mass Index; D005260:Female; D006801:Humans; D008297:Male; D050177:Overweight / Q000150:complications*; D012189:Retrospective Studies; D012771:Shock, Hemorrhagic / Q000209:etiology* / Q000401:mortality*; D013851:Thinness / Q000150:complications*; D014949:Wounds, Nonpenetrating / Q000150:complications*
Blunt trauma; Body mass index; Hemorrhagic shock; Mortality; Obesity; Underweight