Medical Student Case Western Reserve University School of Medicine Cleveland, Ohio, United States
Introduction: Approximately 42% of individuals living within the United States suffer from obesity. The relationship between obesity and outcomes following traumatic brain injury (TBI) is currently understudied. The present study aims to determine the impact of obesity on injury characteristics and clinical outcomes following TBI.
Methods: The American College of Surgeons Trauma Quality Improvement Program 2019 dataset was queried to identify patients ≥ 18 years old presenting with traumatic brain injury. Body-mass-index (BMI) values < 10 and > 70 were excluded from this study to ensure the accuracy of analyses. Patients were stratified using a BMI cut-off of 35 (Class-2 obesity), and Pearson’s Chi-Square and Student’s t-tests were conducted to evaluate differences in injury presentation and clinical outcomes.
Results: A total of 56,950 patients were identified. Average age was 61.9 years, and 62% of patients were male. 5,266 patients had BMI ≥ 35, and 51,684 patients had BMI < 35. These two groups differed in sex (p < 0.001), age (p < 0.001), race (p < 0.001), mode of transportation (p=0.002), payment method (p < 0.001), discharge-disposition (p < 0.001), TBI subtype (SDH/EDH/SAH: p< 0.001, SDH/EDH: p=0.003, SDH/SAH: p< 0.001, EDH/SAH: p< 0.001, SDH: p< 0.001, SAH: p< 0.001), and pupil reactivity (p=0.001). Patients with BMI ≥ 35 had higher rates of interfacility transfer (p < 0.001), longer ICU length of stay (p < 0.001), and longer length of stay on a ventilator (p < 0.001). Interestingly, patients with BMI ≥ 35 had higher Glasgow Coma Scale scores (p=0.003) and lower Injury Severity Scale scores (p < 0.001), Head/Neck Abbreviated Injury Scale scores (p < 0.001), rates of midline shift (p < 0.001), and withdrawal of care (p=0.001).
Conclusion : We demonstrate that TBI patients with a BMI ≥ 35 had statistically-significant differences in injury presentation and clinical outcomes, particularly higher rates of isolated SAH and SDH, as compared to TBI patients with BMI < 35.
