Everyone has an anecdotal tale of a morbidly obese patient who suffered penetrating injury that transversed only adipose tissue, leaving the small person living beneath unharmed. However, these isolated incidents do not appear to apply to blunt trauma.
This study is a retrospective analysis of the National Trauma Data Bank, evaluating 32,780 morbidly obese (BMI >40) and non-obese patients matched 1:1 on age, sex, ISS, GCS, and blood pressure on arrival. Baseline characteristics – as much as could be gleaned retrospectively – showed no substantial imbalance between the two cohorts. And, by nearly every measure, patients with morbid obesity suffered poorer outcomes. ARDS, decubitus ulcers, infectious complications, and thromboembolic complications were all significantly more frequent in this population. These carried forward with increased hospital LOS and increased mortality – 3% vs. 2.2%
Unsurprising, and yet another manner in which obesity shortens lifespan and degrades quality of life.
“Morbid obesity predisposes trauma patients to worse outcomes: A National Trauma Data Bank analysis”
http://www.ncbi.nlm.nih.gov/pubmed/24368375
I wonder how many were carried in by us (EMS) strapped supine to a rigid spine board and immobilized with a rigid collar and left to hang out like that for a while. Certainly sounds like something contributory to an increased M&M.
I can almost guarantee everyone was fully immobilized – almost certainly with a collar that didn't fit properly!