Abstract
BackgroundThere is missing knowledge about the association of obesity and mortality in patients with rib fractures. Since the global measure of obesity (body mass index [BMI]) is often unknown in trauma patients, it would be convenient to use local computed tomography (CT)-based measures (e.g., umbilical outer abdominal fat) as a surrogate. The purpose of this study was to assess (1) whether local measures of obesity and rib fractures are associated with mortality and abdominal injuries and to evaluate (2) the correlation between local and global measures of obesity.Materials and methodsA retrospective cohort study included all inpatients with rib fractures in 2013. The main exposure variable was the rib fracture score (RFS) (number of rib fractures, uni- or bilateral, age). Other exposure variables were CT-based measures of obesity and BMI. The primary outcome (endpoint) was in-hospital mortality. The secondary outcome consisted of abdominal injuries. Sex and comorbidities were adjusted for with logistic regression.ResultsTwo hundred and fifty-nine patients (median age 55.0 [IQR 44.0–72.0] years) were analyzed. Mortality was 8.5%. RFS > 4 was associated with 490% increased mortality (ORadjusted = 5.9, 95% CI 1.9–16.6, p = 0.002). CT-based measures and BMI were not associated with mortality, rib fractures or injury of the liver. CT-based measures of obesity showed moderate correlations with BMI (e.g., umbilical outer abdominal fat: r = 0.59, p < 0.001).ConclusionsRFS > 4 was an independent risk factors for increased mortality. Local and global measures of obesity were not associated with mortality, rib fractures or liver injuries. If the BMI is not available in trauma patients, CT-based measures of obesity may be considered as a surrogate.
Highlights
Multiple rib fractures have been associated with increased mortality in trauma patients and osteoporotic males, there is evidence that rib fractures are not associated with mortality in postmenopausal women and non-stratified patient cohorts [8,9,10,11,12,13]
The body mass index (BMI) was higher in males (25.7 [interquartile range (IQR) 23.9–29.0] versus [vs] 24.2 [21.1–26.8] kg/m2, p = 0.002) (Table 1)
The global and local measures of obesity were not associated with mortality, rib fractures of liver injuries
Summary
Since the global measure of obesity (body mass index [BMI]) is often unknown in trauma patients, it would be convenient to use local computed tomography (CT)-based measures (e.g., umbilical outer abdominal fat) as a surrogate. CT-based measures and BMI were not associated with mortality, rib fractures or injury of the liver. Local and global measures of obesity were not associated with mortality, rib fractures or liver injuries. There are studies that have shown that obesity measured with the BMI is a risk factor for peri-traumatic mortality and complications [4], but others have reported that obesity may be protective of certain injuries (e.g., hip fractures) due to a cushioning effect [5]. One study reported that the BMI is associated with increased incidence rates for multiple rib fractures [6]. Multiple rib fractures have been associated with increased mortality in trauma patients and osteoporotic males, there is evidence that rib fractures are not associated with mortality in postmenopausal women and non-stratified patient cohorts [8,9,10,11,12,13]
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