Dissertation

Pediatric obesity and traumatic lower extremity long bone fracture outcomes

Backstrom, Ian C

2011

Overview

Background. Pediatric obesity is associated with lower extremity injuries and poor outcomes after blunt trauma. Our aim was to determine if obese pediatric patients with femur and tibia fractures have more severe injury patterns and worse outcomes compared to non-obese patients. Methods. We performed a retrospective cohort study of obese and non-obese pediatric patients with femur or tibia fractures treated at two Level-1 trauma centers from 2004–2010. Patients weighing ≥ 95th percentile for age and gender were classified as obese. Patients were compared regarding demographics, Injury Severity Score (ISS), intra-abdominal, and orthopedic injuries. Outcomes included fracture treatment, orthopedic complications, ICU and hospital length of stay, ventilator days, and mortality. Results. Of the 356 patients included in the study, 78 (21.9%) were obese and 278 (78.1%) were non-obese. Obese patients were older (9.9±3.7 vs. 8.8±3.9 years; p=0.0162), had a higher ISS (20.8±13.4 vs. 14.5±10.8; p=0.0002), and sustained more intra-abdominal solid organ (24.4% vs.13.5%; p=0.0200) and hollow viscus (3.9% vs. 0.0%; p=0.0105) injuries. They had more pelvic fractures (15.4% vs. 6.9%; p=0.0196), bilateral tibia fractures (8.0% vs. 0.0%; p=0.0332), and operatively-treated femur fractures (89.9% vs. 79.1%; p=0.0484). Adjusting for age, obese patients were more likely to be admitted to the ICU [relative risk (RR), 1.68; 95% confidence interval (CI), 1.10–2.55] and die in the hospital (RR, 3.45; 95% CI, 1.14–10.41). Adjusting for ISS, these associations were non-significant. Conclusions. Obese patients with femur and tibia fractures have more severe injuries which may predispose them to greater inpatient morbidity and mortality than non-obese patients.

• Publisher: ProQuest Dissertations & Theses
• Subject: Medicine
• ISBN: 1124891242, 9781124891248