Obese patients who fall have less injury severity but a longer hospital stay than normal-weight patients

Jung-Fang Chuang; Cheng-Shyuan Rau; Hang-Tsung Liu; Shao-Chun Wu; Yi-Chun Chen; Shiun-Yuan Hsu; Hsiao-Yun Hsieh; Ching-Hua Hsieh

doi:10.1186/s13017-015-0059-9

Obese patients who fall have less injury severity but a longer hospital stay than normal-weight patients

World J Emerg Surg. 2016 Jan 4:11:3. doi: 10.1186/s13017-015-0059-9. eCollection 2016.

Authors

Jung-Fang Chuang^#¹, Cheng-Shyuan Rau^#², Hang-Tsung Liu¹, Shao-Chun Wu³, Yi-Chun Chen¹, Shiun-Yuan Hsu¹, Hsiao-Yun Hsieh¹, Ching-Hua Hsieh¹

Affiliations

¹ Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Ta-Pei Road, Niao-Sung District, Kaohsiung City, 833 Taiwan.
² Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
³ Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.

^# Contributed equally.

Abstract

Background: The effects of obesity on injury severity and outcome have been studied in trauma patients but not in those who have experienced a fall. The aim of this study was to compare injury patterns, injury severities, mortality rates, and in-hospital or intensive care unit (ICU) length of stay (LOS) between obese and normal-weight patients following a fall.

Methods: Detailed data were retrieved for 273 fall-related hospitalized obese adult patients with a body mass index (BMI) ≥30 kg/m(2) and 2357 normal-weight patients with a BMI <25 kg/m(2) but ≥18.5 kg/m(2) from the Trauma Registry System of a Level I trauma center between January 1, 2009, and December 31, 2013. We used the Pearson's chi-squared test, Fisher's exact test, the Mann Whitney U test, and independent Student's t-test to analyze differences between the two groups.

Results: Analysis of AIS scores and AIS severity scaling from 1 to 5 revealed no significant differences in trauma regions between obese and normal-weight patients. When stratified by injury severity (Injury Severity Score [ISS] of <16, 16-24, or ≥25), more obese patients had an ISS of <16 compared to normal-weight patients (90.5 % vs. 86.0 %, respectively; p = 0.041), while more normal-weight patients had an ISS between 16 and 24 (11.0 % vs. 6.6 %, respectively; p = 0.025). Obese patients who had experienced a fall had a significantly lower ISS (median (range): 9 (1-45) vs. 9 (1-50), respectively; p = 0.015) but longer in-hospital LOS than did normal-weight patients (10.1 days vs. 8.9 days, respectively; p = 0.049). Even after taking account of possible differences in comorbidity and ISS, the obese patients have an average 1.54 day longer LOS than that of normal-weight patients. However, no significant differences were found between obese and normal-weight patients in terms of the New Injury Severity Score (NISS), Trauma-Injury Severity Score (TRISS), mortality, percentage of patients admitted to the ICU, or LOS in the ICU.

Conclusion: Obese patients who had experienced a fall did not have different injured body regions than did normal-weight patients. However, they had a lower ISS but a longer in-hospital LOS than did normal-weight patients.

Keywords: Fall; In-hospital length of stay; Injury severity score; Mortality; Obesity.