Nathan Vaughan1, Jeff Tweed1, Cynthia Greenwell1, David M Notrica2, Crystal S Langlais2, Shawn D St Peter3, Charles M Leys4, Daniel J Ostlie5, R Todd Maxson6, Todd Ponsky7, David W Tuggle8, James W Eubanks9, Amina Bhatia10, Cynthia Greenwell1, Nilda M Garcia8, Karla A Lawson8, Prasenjeet Motghare11, Robert W Letton11, Adam C Alder12. 1. Children's Medical Center Dallas, Dallas, TX 75235. 2. Phoenix Children's Hospital, Phoenix, AZ 85016. 3. Children's Mercy Hospital, Kansas City, MO 64108. 4. American Family Children's Hospital, Madison, WI 53792. 5. Phoenix Children's Hospital, Phoenix, AZ 85016; American Family Children's Hospital, Madison, WI 53792. 6. Arkansas Children's Hospital, Little Rock, AR 72202. 7. Akron Children's Hospital, Akron, OH 44308. 8. Dell Children's Medical Center, Austin, TX 78723. 9. Le Bonheur Children's Hospital, Memphis, TN 38103. 10. Hughes Spalding Children's Hospital, Atlanta, GA 30303. 11. The Children's Hospital at OU Medical Center, Oklahoma City, OK 73104. 12. Children's Medical Center Dallas, Dallas, TX 75235. Electronic address: Adam.Alder@childrens.com.
Abstract
INTRODUCTION: Obesity is an epidemic in the pediatric population. Childhood obesity in trauma has been associated with increased incidence of long-bone fractures, longer ICU stays, and decreased closed head injuries. We investigated for differences in the likelihood of failure of non-operative management (NOM), and injury grade using a subset of a multi-institutional, prospective database of pediatric patients with solid organ injury (SOI). METHODS: We prospectively collected data on all pediatric patients (<18years) admitted for liver or splenic injury from September 2013 to January 2016. SOI was managed based upon the ATOMAC protocol. Obesity status was derived using CDC definitions; patients were categorized as non-obese (BMI <95th percentile) or obese (BMI ≥95th percentile). The ISS, injury grade, and NOM failure rate were calculated among other data points. RESULTS: Of 1012 patients enrolled, 117 were identified as having data regarding BMI. Eighty-four percent of patients were non-obese; 16% were obese. The groups did not differ by age, sex, mechanism of injury, or associated injuries. There was no significant difference in the rate of failure of non-operative management (8.2% versus 5.3%). Obesity was associated with higher likelihood of severe (grade 4 or 5) hepatic injury (36.8% versus 15.3%, P=0.048) but not a significant difference in likelihood of severe (grade 4 or 5) splenic injury (15.3% versus 10.5%, P=0.736). Obese patients had a higher mean ISS (22.5 versus 16.1, P=0.021) and mean abdominal AIS (3.5 versus 2.9, P=0.024). CONCLUSION: Obesity is a risk factor for more severe abdominal injury, specifically liver injury, but without an associated increase in failure of NOM. This may be explained by the presence of hepatic steatosis making the liver more vulnerable to injury. A protocol based upon physiologic parameters was associated with a low rate of failure regardless of the pediatric obesity status. LEVEL OF EVIDENCE: Level II prognosis.
INTRODUCTION:Obesity is an epidemic in the pediatric population. Childhood obesity in trauma has been associated with increased incidence of long-bone fractures, longer ICU stays, and decreased closed head injuries. We investigated for differences in the likelihood of failure of non-operative management (NOM), and injury grade using a subset of a multi-institutional, prospective database of pediatric patients with solid organ injury (SOI). METHODS: We prospectively collected data on all pediatric patients (<18years) admitted for liver or splenic injury from September 2013 to January 2016. SOI was managed based upon the ATOMAC protocol. Obesity status was derived using CDC definitions; patients were categorized as non-obese (BMI <95th percentile) or obese (BMI ≥95th percentile). The ISS, injury grade, and NOM failure rate were calculated among other data points. RESULTS: Of 1012 patients enrolled, 117 were identified as having data regarding BMI. Eighty-four percent of patients were non-obese; 16% were obese. The groups did not differ by age, sex, mechanism of injury, or associated injuries. There was no significant difference in the rate of failure of non-operative management (8.2% versus 5.3%). Obesity was associated with higher likelihood of severe (grade 4 or 5) hepatic injury (36.8% versus 15.3%, P=0.048) but not a significant difference in likelihood of severe (grade 4 or 5) splenic injury (15.3% versus 10.5%, P=0.736). Obesepatients had a higher mean ISS (22.5 versus 16.1, P=0.021) and mean abdominal AIS (3.5 versus 2.9, P=0.024). CONCLUSION:Obesity is a risk factor for more severe abdominal injury, specifically liver injury, but without an associated increase in failure of NOM. This may be explained by the presence of hepatic steatosis making the liver more vulnerable to injury. A protocol based upon physiologic parameters was associated with a low rate of failure regardless of the pediatric obesity status. LEVEL OF EVIDENCE: Level II prognosis.
Authors: Allen K Chen; David Jeffcoach; John C Stivers; Kyle A McCullough; Rachel C Dirks; Ryland J Boehnke; Lawrence Sue; Amy M Kwok; Mary M Wolfe; James W Davis Journal: Trauma Surg Acute Care Open Date: 2019-07-12