title: Trauma injury in adult underweight patients: A cross-sectional study based on the trauma registry system of a level I trauma center.
abstract: The aim of this study was to investigate and compare the injury characteristics, severity, and outcome between underweight and normal-weight patients hospitalized for the treatment of all kinds of trauma injury.This study was based on a level I trauma center Taiwan.The detailed data of 640 underweight adult trauma patients with a body mass index (BMI) of <18.5 kg/m and 6497 normal-weight adult patients (25 > BMI ≥ 18.5 kg/m) were retrieved from the Trauma Registry System between January 1, 2009, and December 31, 2014. Pearson's chi-square test, Fisher's exact test, and independent Student's t-test were performed to compare the differences. Propensity score matching with logistic regression was used to evaluate the effect of underweight on mortality.Underweight patients presented a different bodily injury pattern and a significantly higher rate of admittance to the intensive care unit (ICU) than did normal-weight patients; however, no significant differences in the Glasgow Coma Scale (GCS) score, injury severity score (ISS), in-hospital mortality, and hospital length of stay were found between the two groups. However, further analysis of the patients stratified by two major injury mechanisms (motorcycle accident and fall injury) revealed that underweight patients had significantly lower GCS scores (13.8 ± 3.0 vs 14.5 ± 2.0, P = 0.020), but higher ISS (10.1 ± 6.9 vs 8.4 ± 5.9, P = 0.005), in-hospital mortality (odds ratio, 4.4; 95% confidence interval, 1.69-11.35; P = 0.006), and ICU admittance rate (24.1% vs 14.3%, P = 0.007) than normal-weight patients in the fall accident group, but not in the motorcycle accident group. However, after propensity score matching, logistic regression analysis of well-matched pairs of patients with either all trauma, motorcycle accident, or fall injury did not show a significant influence of underweight on mortality.Exploratory data analysis revealed that underweight patients presented a different bodily injury pattern from that of normal-weight patients, specifically a higher incidence of pneumothorax in those with penetrating injuries and of femoral fracture in those with struck on/against injuries; however, the injury severity and outcome of underweight patients varied depending on the injury mechanism.
authors.affiliation: Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taiwan Department of Anesthesiology Department of Plastic and Reconstructive Surgery.
authors.forename: Ching-Hua
authors.initials: CH
authors.lastname: Hsieh
authors.forename: Wei-Hung
authors.initials: WH
authors.lastname: Lai
authors.forename: Shao-Chun
authors.initials: SC
authors.lastname: Wu
authors.forename: Yi-Chun
authors.initials: YC
authors.lastname: Chen
authors.forename: Pao-Jen
authors.initials: PJ
authors.lastname: Kuo
authors.forename: Shiun-Yuan
authors.initials: SY
authors.lastname: Hsu
authors.forename: Hsiao-Yun
authors.initials: HY
authors.lastname: Hsieh
mesh_terms: D000058:Accidental Falls / Q000401:mortality; D000063:Accidents, Traffic / Q000401:mortality; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009049:Motorcycles; D012042:Registries; D013624:Taiwan / Q000453:epidemiology; D013851:Thinness; D014193:Trauma Centers / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000401:mortality*; D055815:Young Adult