SLR - April 2010 - Jashan Valjee
Reference:
Rana, A.R., Michalsky, M.P., Teich, S., Groner, J.I., Caniano, D.A., Schuster, D.P. (2009). Childhood obesity: A risk factor for injuries ovserved at a level-1 trauma center. Journal of Pediatric Surgery,44(8),1601-5.
Scientific Literature Reviews
Reviewed by: Jashan Valjee, DPM
Residency Program: Detroit Medical Center
Podiatric Relevance:
This article dicusses the correlation of childhood obesity with an increase in the risk for extremity fractures requiring surgical intervention in addition to other complications including decubitus ulcerations and deep venous thrombosis.
Methods:
This is a retrospective study from January 2004 to July 2007 comparing a nonobese pediatric patient group (body mass index [BMI] < 95th percentile for age) and an obese patient group (BMI > 95th percentile). The two pediatric trauma groups (ages 6-20) were analyzed for demographics, initial vital signs, mechanisms of injury, length of stay, intensive care unit stay, ventilator days, Injury Severity Score, operative procedures, and clinical outcomes.
Results:
A total of 1316 patients were reviewed with 1020 (77%) nonobese (mean BMI = 18.8 kg/m2) and 294 (23%) obese patients (mean BMI = 29.7 kg/m2). According to the study, there were no statistically significant differences in sex, heart rate, length of stay, intensive care unit days, ventilator days, Injury Severity Score, and mortality between the groups. The obese group was markedly younger (10.9 +/- 3.3 vs 11.5 +/- 3.5 years; P = .008) and averaged a higher systolic blood pressure (128 +/- 17 vs 124 +/- 16 mm Hg, P < .001). It was also noted that the obese population had an increased rate of extremity fractures (55% vs 40%; P < .001) that required orthopedic surgical intervention (42% vs 30%; P < .001). However, the obese patients had a lower incidence of intracranial (12% vs 18%; P = .013) and intraabdominal injuries (6% vs 11%; P = .023). Finally, the obese group had a higher rate of complications in the form of decubitus ulcerations (P < .043) and deep vein thrombosis (P < .008).
Conclusions:
For pediatric trauma patients, obesity may be a risk factor in extremity fractures requiring orthopaedic surgical reduction with associated complications of decubitus ulcers and deep vein thrombosis, despite having a lower incidence of closed head and intraabdominal injuries.