APSA Paper
The impact of obesity on severely injured children and adolescents

https://doi.org/10.1016/j.jpedsurg.2005.10.012Get rights and content

Abstract

Purpose/Background

In conjunction with the obesity epidemic in adults, we are starting to see an increase of obesity in children and adolescents. Obesity has been identified as risk factor for poor outcomes in adult trauma patients, but has not been investigated adequately in younger patients. The purpose of this study was to investigate the impact of obesity on the outcomes of a severely injured population of children and adolescents.

Methods

Retrospective review of traumatized children (age 6-12) and adolescents (age 13-19) admitted to the intensive care unit (ICU) at an urban, level I trauma center from 1998 to 2003. The trauma registry and ICU database were used for data acquisition. Height and weight were recorded for each patient upon admission to the ICU and used to calculate body mass index (BMI). Patients were categorized as either lean (BMI <95th percentile for age) or obese (BMI ≥95th percentile for age). The two groups were compared regarding admission demographics, vital signs, mechanism of injury, patterns of injury, Injury Severity Score, and operations required. Outcomes evaluated were need for and length of mechanical ventilation, complications, length of hospital and ICU stay, and mortality.

Results

There were 316 pediatric and adolescent trauma patients (262 [83%] lean, mean BMI = 23 kg/m2 and 54 [17%] obese, mean BMI = 33 kg/m2) admitted to the ICU. The lean and obese groups were similar regarding age, sex, mechanism of injury, admission vitals, injury severity, and operations required. Injury patterns were similar, except obese patients had less severe head injuries. Although there was no difference in mortality among obese (15%) and non-obese (9%) patients (P = .39), obese children did have more complications (41% vs 22%, P = .04). In addition, obese patients required longer ICU stays (8 ± 9 vs 6 ± 6 days, P = .05) after severe trauma.

Conclusions

Despite similar admission characteristics and less severe head injuries, obese children and adolescents have more complications and require longer ICU stays than their lean counterparts.

Section snippets

Patients and methods

This was a retrospective review of all pediatric (6-11 years old) and adolescent (12-19 years old) trauma patients admitted to the surgical intensive care unit (ICU) at LAC/USC Medical Center from 1998 through 2003. All patients are weighed and measured upon admission to our ICU and values were used to calculate body mass index (BMI, reported in kg/m2) for each patient. Patients were subsequently classified as either obese (BMI ≥95th percentile for age) or non-obese (BMI <95th percentile for

Results

There were 316 pediatric and adolescent trauma patients admitted to our ICU during the 5-year study period, including 54 obese (17%, mean BMI = 33 ± 5 kg/m2) and 262 non-obese (83%, mean BMI = 23 ± 4 kg/m2) patients. Obese and non-obese patients were similar regarding age (16 ± 4 vs 15 ± 4 years, P = .14), male sex (76% vs 81%, P = .48), and blunt mechanism of injury (50% vs 44%, P = .55). Although there was no difference in admission heart rate (109 ± 28 vs 104 ± 29 beats per minute, P = .23),

Discussion

Obesity has become a nationwide epidemic and has even afflicted an alarming number of our country's youth. The prevalence of pediatric obesity has more than doubled over the past 20 years, with about 15% of children and adolescents currently exceeding the 95th percentile for BMI [1], [2], with even higher rates among minority and economically disadvantaged children. In parallel to this rise in obese children, trauma continues as the leading cause of morbidity, mortality, and functional

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Presented at the 36th Annual Meeting of the American Pediatric Surgical Association, Phoenix, AZ, May 29-June 1, 2005.

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