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The Relationship Between Body Mass Index and Abdominal Circumference with Intraabdominal Organ Injury in High Energy Blunt Abdominal Trauma

Year 2024, Volume: 7 Issue: 3, 121 - 126, 28.09.2024
https://doi.org/10.54996/anatolianjem.1477433

Abstract

Aim: The aim of this study was to determine the impact of body mass index (BMI) and abdominal circumference on intra-abdominal organ injury in high energy blunt trauma patients presenting to the emergency department.

Material and Methods: This prospective, cross-sectional, and analytical study included patients who presented to the Ankara Bilkent City Hospital Emergency Medicine Clinic between June 15, 2022, and December 31, 2022, due to high-energy blunt trauma and underwent contrast-enhanced abdominal computed tomography (CT). Patient demographics, vital signs, height, weight, BMI, mechanism of injury, abdominal injuries, injuries to other systems, abdominal circumference measurements, emergency department outcomes, and laboratory results were recorded in the data collection form. CT images were evaluated by a single radiology specialist, and abdominal circumference and subcutaneous fat tissue thickness were measured.

Results: A total of 374 patients were included in the study. 71.9% of the patients were male (n=269). The average age of the patients was 40 ± 16 years. Intra-abdominal injury was observed most frequently (30.8%) in patients with a BMI <18.5 (p=0.017). Although patients with intra-abdominal injury had lower sagittal abdominal diameter (SAD), transverse external diameter (T-ext), subcutaneous fat (Sc-fat), and BMI averages, these findings were not statistically significant (p=0.321, p=0.666, p=0.172, p=0.595, respectively). Patients admitted to the intensive care unit had lower SAD (20.6 ± 4.0 cm), T-ext (30.7 ± 3.9 cm), Sc-fat (2.0 ± 1.0 cm), and BMI (24.9 ± 4.4 kg/m2) averages (p=0.003, p=0.009, p=0.006, p=0.007, respectively).

Conclusion: Patients with a BMI <18.5 were found to be more susceptible to intra-abdominal injury. Patients with lower abdominal circumference (SAD, T-ext), Sc-fat, and BMI values were more likely to be admitted to the intensive care unit. Therefore, it is important to be cautious regarding abdominal injuries and injuries requiring intensive care admission in underweight and normal-weight patients who have experienced high-energy blunt trauma.

Ethical Statement

I declare that this study is an original work, and I have adhered to the scientific ethical principles and rules at all stages of preparation, data collection, analysis, and presentation of information. I acknowledge that for all data and information not obtained within the scope of this study, I have provided proper attribution to the sources used, and I have included these sources in the references. I confirm that no alterations have been made to the data used, and I abide by the ethical duties and responsibilities by accepting all terms and conditions of the Committee on Publication Ethics (COPE). I hereby state that I am aware and consent to all moral and legal consequences that may arise if any discrepancy with this declaration regarding the study is identified at any time.

Supporting Institution

The study received no financial support.

Thanks

I would like to thank my esteemed professors for their efforts during my assistantship process and for their contributions to this article.

References

  • Rhee P, Joseph B, Pandit V, et al. Increasing trauma deaths in the United States. Ann Surg. 2014;260(1):13–21.
  • New publications show injuries kill more than five million people a year [Internet]. [cited 2023 Mar 4]. Available from: https://www.who.int/news/item/12-05-2003-new-publications-show-injuries-kill-more-than-five-million-people-a-year
  • Demetriades D, Murray J, Charalambides K, et al. Trauma fatalities: Time and location of hospital deaths. J Am Coll Surg. 2004;198(1):20–6.
  • Intravia JM, DeBerardino TM. Evaluation of Blunt Abdominal Trauma. Clin Sports Med. 2013 Apr;32(2):211–8.
  • Arenaza Choperena G, Cuetos Fernández J, Gómez Usabiaga V, Ugarte Nuño A, Rodriguez Calvete P, Collado Jiménez J. Abdominal trauma. Radiologia (Engl Ed). 2023 Mar;65 Suppl 1:S32-S41.
  • Soto JA, Anderson SW. Multidetector CT of blunt abdominal trauma. Vol. 265, Radiology. 2012. p. 678–93.
  • Pouliot MC, Després JP, Lemieux S, et al. Waist circumference and abdominal sagittal diameter: best simple anthropometric indexes of abdominal visceral adipose tissue accumulation and related cardiovascular risk in men and women. Am J Cardiol. 1994 Mar 1;73(7):460–8.
  • Jonnalagadda SS, Skinner R, Moore L, Address RD. Overweight Athlete: Fact or Fiction? 2004.
  • Boutari C, Mantzoros CS. A 2022 update on the epidemiology of obesity and a call to action: as its twin COVID- 19 pandemic appears to be receding, the obesity and dysmetabolism pandemic continues to rage on. Metabolism. 2022 Aug 1;133.
  • Durgun HM, Dursun R, Zengin Y, et al. The effect of body mass index on trauma severity and prognosis in trauma patients. Ulus Travma Acil Cerrahi Derg. 2016 Sep 1;22(5):457–65.
  • Rothman KJ. BMI-related errors in the measurement of obesity. Int J Obes (Lond). 2008;32 Suppl 3:S56–9.
  • Clerc D, Blaser B, Demartines N, Christofordis D. Sagittal Abdominal Diameter is a Better Predictor than Body Mass Index for Duration of Laparoscopic Left Colectomy. World Journal of Surgery, 39(3), 769–775 | 10.1007/s00268-014-2877-4.
  • Yim JY, Kim D, Lim SH, et al. Sagittal abdominal diameter is a strong anthropometric measure of visceral adipose tissue in the Asian general population. Diabetes Care. 2010 Dec;33(12):2665-70.
  • Alberdi F, García I, Atutxa L, Zabarte M. Epidemiology of severe trauma. Med Intensiva. 2014 Dec 1;38(9):580–8.
  • Arbabi S, Wahl WL, Hemmila MR, Kohoyda-Inglis C, Taheri PA, Wang SC. The cushion effect. J Trauma. 2003 Jun;54(6):1090-3.
  • Liu T, Xie J, Yang F, Chen JJ, Li ZF, Yi C La, et al. The influence of sex on outcomes in trauma patients: a meta-analysis. Am J Surg. 2015 Nov 1;210(5):911–21.
  • Zhu Z, Shang X, Qi P, Ma S. Sex-based differences in outcomes after severe injury: an analysis of blunt trauma patients in China. Scand J Trauma Resusc Emerg Med. 2017 May 2;25(1).
  • Bolandparvaz S, Yadollahi M, Abbasi HR, Anvar M. Injury patterns among various age and gender groups of trauma patients in southern Iran: A cross-sectional study. Medicine. 2017 Oct 1;96(41).
  • Srivastava AR, Kumar S, Agarwal GG, Ranjan P. Blunt abdominal injury: serum ALT-A marker of liver injury and a guide to assessment of its severity. Injury. 2007 Sep;38(9):1069–74.
  • Sierink JC, Treskes K, Edwards MJR, et al. Immediate total-body CT scanning versus conventional imaging and selective CT scanning in patients with severe trauma (REACT-2): a randomised controlled trial. Lancet. 2016 Aug 13;388(10045):673–83.
  • Jones EL, Stovall RT, Jones TS, Bensard DD, Burlew CC, Johnson JL, Jurkovich GJ, Barnett CC, Pieracci FM, Biffl WL, Moore EE. Intra-abdominal injury following blunt trauma becomes clinically apparent within 9 hours. J Trauma Acute Care Surg. 2014 Apr;76(4):1020-3.
  • Ditillo M, Pandit V, Rhee P, et al. Morbid obesity predisposes trauma patients to worse outcomes: a National Trauma Data Bank analysis. J Trauma Acute Care Surg. 2014 Jan;76(1):176–9.
  • Alvarez BD, Razente DM, Lacerda DAM, Lother NS, Von-Bahten LC, Stahlschmidt CMM. Analysis of the Revised Trauma Score (RTS) in 200 victims of different trauma mechanisms. Rev Col Bras Cir. 2016 Sep 1;43(5):334–40.
  • Bouzat P, Legrand R, Gillois P, et al. Prediction of intra-hospital mortality after severe trauma: which pre-hospital score is the most accurate? Injury. 2016 Jan 1;47(1):14–8.
  • Ion D, Gherghinescu M, Andronic O, et al. Prognosis Evaluation for Patients with Abdominal Trauma Using Usual Biological Parameters. Chirurgia (Bucur). 2021 Dec;116(6):737-747.
  • Musalar E, Ersel M, Akarca FK, Kıyan GS, Can Ö. The predictive value of biochemical parameters in evaluating patients with abdominal trauma: The new scoring system. Turk J Emerg Med. 2017 Jan 4;17(2):48-55.
  • Choi J, Smiley A, Latifi R, et al. Body Mass Index and Mortality in Blunt Trauma: The Right BMI can be Protective. Am J Surg. 2020 Dec 1;220(6):1475–9.
  • Christensen MC, Ridley S, Lecky FE, Munro V, Morris S. Outcomes and costs of blunt trauma in England and Wales. Crit Care. 2008 Feb 19;12(1).
  • Boulanger BR, Milzman D, Mitchell K, Rodriguez A. Body habitus as a predictor of injury pattern after blunt trauma. J Trauma [Internet]. 1992 [cited 2023 Apr 18];33(2):228–32. Available from: https://pubmed.ncbi.nlm.nih.gov/1507286/
  • Wang SC, Bednarski B, Patel S, et al. Increased depth of subcutaneous fat is protective against abdominal injuries in motor vehicle collisions. Annu Proc Assoc Adv Automot Med. 2003;47:545–59.

Yüksek Enerjili Künt Karın Travmalarında Vücut Kitle İndeksi ve Karın Çevresi ile Karın İçi Organ Yaralanması Arasındaki İlişki

Year 2024, Volume: 7 Issue: 3, 121 - 126, 28.09.2024
https://doi.org/10.54996/anatolianjem.1477433

Abstract

Amaç: Bu çalışmanın amacı, acil servise başvuran yüksek enerjili künt travma hastalarında vücut kitle indeksi (VKİ) ve karın çevresinin karın içi organ yaralanması üzerindeki etkisini belirlemektir.

Gereç ve Yöntemler: Bu prospektif, kesitsel ve analitik çalışmaya, 15 Haziran 2022 ile 31 Aralık 2022 tarihleri arasında Ankara Bilkent Şehir Hastanesi Acil Tıp Kliniğine yüksek enerjili künt travma nedeniyle başvuran ve kontrastlı abdominal bilgisayarlı tomografi (BT) çekilen hastalar dahil edilmiştir. Hastaların demografik bilgileri, yaşamsal bulguları, boy, kilo, VKİ, yaralanma mekanizması, karın yaralanmaları, diğer sistem yaralanmaları, karın çevresi ölçümleri, acil servis sonlanımı ve laboratuvar sonuçları veri toplama formuna kaydedildi. BT görüntüleri tek bir radyoloji uzmanı tarafından değerlendirildi, karın çevresi ve deri altı yağ dokusu kalınlığı ölçüldü.

Bulgular: Çalışmaya toplam 374 hasta dahil edilmiştir ve %71,9'u (n=269) erkektir. Hastaların yaş ortalaması 40 ± 16 idi. İntraabdominal yaralanma en sık (%30,8) VKİ <18,5 olan hastalarda gözlendi (p=0,017). Karın içi yaralanması olan hastaların sagittal karın çapı (SKÇ), transvers dış çapı (TDÇ), deri altı yağ ve VKİ ortalamaları daha düşük olmasına rağmen, bu bulgular istatistiksel olarak anlamlı değildi (sırasıyla p=0.321, p=0.666, p=0.172, p=0.595). Yoğun bakım ünitesine kabul edilen hastaların SKÇ (20,6 ± 4,0 cm), TDÇ (30,7 ± 3,9 cm), deri altı yağ (2,0 ± 1,0 cm) ve VKİ (24,9 ± 4,4 kg/m2) ortalamaları daha düşüktü (sırasıyla p=0,003, p=0,009, p=0,006, p=0,007).

Sonuç: VKİ <18,5 olan hastalar karın içi yaralanmaya daha yatkın bulundu. Daha düşük karın çevresi (SKÇ, TDÇ), deri altı yağ ve VKİ değerlerine sahip hastaların yoğun bakım ünitesine kabul edilme olasılığı daha yüksekti. Bu nedenle, yüksek enerjili künt travma geçiren zayıf ve normal kilolu hastalarda karın yaralanmaları ve yoğun bakıma yatış gerektiren yaralanmalar konusunda dikkatli olmak önemlidir.

References

  • Rhee P, Joseph B, Pandit V, et al. Increasing trauma deaths in the United States. Ann Surg. 2014;260(1):13–21.
  • New publications show injuries kill more than five million people a year [Internet]. [cited 2023 Mar 4]. Available from: https://www.who.int/news/item/12-05-2003-new-publications-show-injuries-kill-more-than-five-million-people-a-year
  • Demetriades D, Murray J, Charalambides K, et al. Trauma fatalities: Time and location of hospital deaths. J Am Coll Surg. 2004;198(1):20–6.
  • Intravia JM, DeBerardino TM. Evaluation of Blunt Abdominal Trauma. Clin Sports Med. 2013 Apr;32(2):211–8.
  • Arenaza Choperena G, Cuetos Fernández J, Gómez Usabiaga V, Ugarte Nuño A, Rodriguez Calvete P, Collado Jiménez J. Abdominal trauma. Radiologia (Engl Ed). 2023 Mar;65 Suppl 1:S32-S41.
  • Soto JA, Anderson SW. Multidetector CT of blunt abdominal trauma. Vol. 265, Radiology. 2012. p. 678–93.
  • Pouliot MC, Després JP, Lemieux S, et al. Waist circumference and abdominal sagittal diameter: best simple anthropometric indexes of abdominal visceral adipose tissue accumulation and related cardiovascular risk in men and women. Am J Cardiol. 1994 Mar 1;73(7):460–8.
  • Jonnalagadda SS, Skinner R, Moore L, Address RD. Overweight Athlete: Fact or Fiction? 2004.
  • Boutari C, Mantzoros CS. A 2022 update on the epidemiology of obesity and a call to action: as its twin COVID- 19 pandemic appears to be receding, the obesity and dysmetabolism pandemic continues to rage on. Metabolism. 2022 Aug 1;133.
  • Durgun HM, Dursun R, Zengin Y, et al. The effect of body mass index on trauma severity and prognosis in trauma patients. Ulus Travma Acil Cerrahi Derg. 2016 Sep 1;22(5):457–65.
  • Rothman KJ. BMI-related errors in the measurement of obesity. Int J Obes (Lond). 2008;32 Suppl 3:S56–9.
  • Clerc D, Blaser B, Demartines N, Christofordis D. Sagittal Abdominal Diameter is a Better Predictor than Body Mass Index for Duration of Laparoscopic Left Colectomy. World Journal of Surgery, 39(3), 769–775 | 10.1007/s00268-014-2877-4.
  • Yim JY, Kim D, Lim SH, et al. Sagittal abdominal diameter is a strong anthropometric measure of visceral adipose tissue in the Asian general population. Diabetes Care. 2010 Dec;33(12):2665-70.
  • Alberdi F, García I, Atutxa L, Zabarte M. Epidemiology of severe trauma. Med Intensiva. 2014 Dec 1;38(9):580–8.
  • Arbabi S, Wahl WL, Hemmila MR, Kohoyda-Inglis C, Taheri PA, Wang SC. The cushion effect. J Trauma. 2003 Jun;54(6):1090-3.
  • Liu T, Xie J, Yang F, Chen JJ, Li ZF, Yi C La, et al. The influence of sex on outcomes in trauma patients: a meta-analysis. Am J Surg. 2015 Nov 1;210(5):911–21.
  • Zhu Z, Shang X, Qi P, Ma S. Sex-based differences in outcomes after severe injury: an analysis of blunt trauma patients in China. Scand J Trauma Resusc Emerg Med. 2017 May 2;25(1).
  • Bolandparvaz S, Yadollahi M, Abbasi HR, Anvar M. Injury patterns among various age and gender groups of trauma patients in southern Iran: A cross-sectional study. Medicine. 2017 Oct 1;96(41).
  • Srivastava AR, Kumar S, Agarwal GG, Ranjan P. Blunt abdominal injury: serum ALT-A marker of liver injury and a guide to assessment of its severity. Injury. 2007 Sep;38(9):1069–74.
  • Sierink JC, Treskes K, Edwards MJR, et al. Immediate total-body CT scanning versus conventional imaging and selective CT scanning in patients with severe trauma (REACT-2): a randomised controlled trial. Lancet. 2016 Aug 13;388(10045):673–83.
  • Jones EL, Stovall RT, Jones TS, Bensard DD, Burlew CC, Johnson JL, Jurkovich GJ, Barnett CC, Pieracci FM, Biffl WL, Moore EE. Intra-abdominal injury following blunt trauma becomes clinically apparent within 9 hours. J Trauma Acute Care Surg. 2014 Apr;76(4):1020-3.
  • Ditillo M, Pandit V, Rhee P, et al. Morbid obesity predisposes trauma patients to worse outcomes: a National Trauma Data Bank analysis. J Trauma Acute Care Surg. 2014 Jan;76(1):176–9.
  • Alvarez BD, Razente DM, Lacerda DAM, Lother NS, Von-Bahten LC, Stahlschmidt CMM. Analysis of the Revised Trauma Score (RTS) in 200 victims of different trauma mechanisms. Rev Col Bras Cir. 2016 Sep 1;43(5):334–40.
  • Bouzat P, Legrand R, Gillois P, et al. Prediction of intra-hospital mortality after severe trauma: which pre-hospital score is the most accurate? Injury. 2016 Jan 1;47(1):14–8.
  • Ion D, Gherghinescu M, Andronic O, et al. Prognosis Evaluation for Patients with Abdominal Trauma Using Usual Biological Parameters. Chirurgia (Bucur). 2021 Dec;116(6):737-747.
  • Musalar E, Ersel M, Akarca FK, Kıyan GS, Can Ö. The predictive value of biochemical parameters in evaluating patients with abdominal trauma: The new scoring system. Turk J Emerg Med. 2017 Jan 4;17(2):48-55.
  • Choi J, Smiley A, Latifi R, et al. Body Mass Index and Mortality in Blunt Trauma: The Right BMI can be Protective. Am J Surg. 2020 Dec 1;220(6):1475–9.
  • Christensen MC, Ridley S, Lecky FE, Munro V, Morris S. Outcomes and costs of blunt trauma in England and Wales. Crit Care. 2008 Feb 19;12(1).
  • Boulanger BR, Milzman D, Mitchell K, Rodriguez A. Body habitus as a predictor of injury pattern after blunt trauma. J Trauma [Internet]. 1992 [cited 2023 Apr 18];33(2):228–32. Available from: https://pubmed.ncbi.nlm.nih.gov/1507286/
  • Wang SC, Bednarski B, Patel S, et al. Increased depth of subcutaneous fat is protective against abdominal injuries in motor vehicle collisions. Annu Proc Assoc Adv Automot Med. 2003;47:545–59.
There are 30 citations in total.

Details

Primary Language English
Subjects Emergency Medicine
Journal Section Original Articles
Authors

Alper Üzülmez 0009-0002-1932-9837

Ayhan Özhasenekler 0000-0002-2707-4099

Esra Çıvgın 0000-0003-4790-3146

Alp Şener 0000-0002-0583-2936

Mehmet Ergin 0000-0002-9420-6514

Şervan Gökhan 0000-0002-1758-3383

Early Pub Date September 27, 2024
Publication Date September 28, 2024
Submission Date May 3, 2024
Acceptance Date July 28, 2024
Published in Issue Year 2024 Volume: 7 Issue: 3

Cite

AMA Üzülmez A, Özhasenekler A, Çıvgın E, Şener A, Ergin M, Gökhan Ş. The Relationship Between Body Mass Index and Abdominal Circumference with Intraabdominal Organ Injury in High Energy Blunt Abdominal Trauma. Anatolian J Emerg Med. September 2024;7(3):121-126. doi:10.54996/anatolianjem.1477433