The impact of morbid obesity on solid organ injury in children using the ATOMAC protocol at a pediatric level I trauma center

Nathan Vaughan, Jeff Tweed, Cynthia Greenwell, David M. Notrica, Crystal S. Langlais, Shawn D.St Peter, Charles M. Leys, Daniel J. Ostlie, R. Todd Maxson, Todd Ponsky, David W. Tuggle, James Eubanks, Amina Bhatia, Cynthia Greenwell, Nilda M. Garcia, Karla A. Lawson, Prasenjeet Motghare, Robert W. Letton, Adam C. Alder

Research output: Contribution to journalArticle

2 Citations (Scopus)

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 (< 18 years) 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.

Original languageEnglish (US)
Pages (from-to)345-348
Number of pages4
JournalJournal of pediatric surgery
Volume52
Issue number2
DOIs
StatePublished - Feb 1 2017

Fingerprint

Morbid Obesity
Trauma Centers
Pediatrics
Wounds and Injuries
Obesity
Pediatric Obesity
Liver
Closed Head Injuries
Abdominal Injuries
Bone Fractures
Fatty Liver
Centers for Disease Control and Prevention (U.S.)
Databases

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

Vaughan, N., Tweed, J., Greenwell, C., Notrica, D. M., Langlais, C. S., Peter, S. D. S., ... Alder, A. C. (2017). The impact of morbid obesity on solid organ injury in children using the ATOMAC protocol at a pediatric level I trauma center. Journal of pediatric surgery, 52(2), 345-348. https://doi.org/10.1016/j.jpedsurg.2016.09.002

The impact of morbid obesity on solid organ injury in children using the ATOMAC protocol at a pediatric level I trauma center. / Vaughan, Nathan; Tweed, Jeff; Greenwell, Cynthia; Notrica, David M.; Langlais, Crystal S.; Peter, Shawn D.St; Leys, Charles M.; Ostlie, Daniel J.; Maxson, R. Todd; Ponsky, Todd; Tuggle, David W.; Eubanks, James; Bhatia, Amina; Greenwell, Cynthia; Garcia, Nilda M.; Lawson, Karla A.; Motghare, Prasenjeet; Letton, Robert W.; Alder, Adam C.

In: Journal of pediatric surgery, Vol. 52, No. 2, 01.02.2017, p. 345-348.

Research output: Contribution to journalArticle

Vaughan, N, Tweed, J, Greenwell, C, Notrica, DM, Langlais, CS, Peter, SDS, Leys, CM, Ostlie, DJ, Maxson, RT, Ponsky, T, Tuggle, DW, Eubanks, J, Bhatia, A, Greenwell, C, Garcia, NM, Lawson, KA, Motghare, P, Letton, RW & Alder, AC 2017, 'The impact of morbid obesity on solid organ injury in children using the ATOMAC protocol at a pediatric level I trauma center', Journal of pediatric surgery, vol. 52, no. 2, pp. 345-348. https://doi.org/10.1016/j.jpedsurg.2016.09.002
Vaughan, Nathan ; Tweed, Jeff ; Greenwell, Cynthia ; Notrica, David M. ; Langlais, Crystal S. ; Peter, Shawn D.St ; Leys, Charles M. ; Ostlie, Daniel J. ; Maxson, R. Todd ; Ponsky, Todd ; Tuggle, David W. ; Eubanks, James ; Bhatia, Amina ; Greenwell, Cynthia ; Garcia, Nilda M. ; Lawson, Karla A. ; Motghare, Prasenjeet ; Letton, Robert W. ; Alder, Adam C. / The impact of morbid obesity on solid organ injury in children using the ATOMAC protocol at a pediatric level I trauma center. In: Journal of pediatric surgery. 2017 ; Vol. 52, No. 2. pp. 345-348.
@article{d1a79b53b347409688391f95955c50a3,
title = "The impact of morbid obesity on solid organ injury in children using the ATOMAC protocol at a pediatric level I trauma center",
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 (< 18 years) 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.",
author = "Nathan Vaughan and Jeff Tweed and Cynthia Greenwell and Notrica, {David M.} and Langlais, {Crystal S.} and Peter, {Shawn D.St} and Leys, {Charles M.} and Ostlie, {Daniel J.} and Maxson, {R. Todd} and Todd Ponsky and Tuggle, {David W.} and James Eubanks and Amina Bhatia and Cynthia Greenwell and Garcia, {Nilda M.} and Lawson, {Karla A.} and Prasenjeet Motghare and Letton, {Robert W.} and Alder, {Adam C.}",
year = "2017",
month = "2",
day = "1",
doi = "10.1016/j.jpedsurg.2016.09.002",
language = "English (US)",
volume = "52",
pages = "345--348",
journal = "Journal of Pediatric Surgery",
issn = "0022-3468",
publisher = "W.B. Saunders Ltd",
number = "2",

}

TY - JOUR

T1 - The impact of morbid obesity on solid organ injury in children using the ATOMAC protocol at a pediatric level I trauma center

AU - Vaughan, Nathan

AU - Tweed, Jeff

AU - Greenwell, Cynthia

AU - Notrica, David M.

AU - Langlais, Crystal S.

AU - Peter, Shawn D.St

AU - Leys, Charles M.

AU - Ostlie, Daniel J.

AU - Maxson, R. Todd

AU - Ponsky, Todd

AU - Tuggle, David W.

AU - Eubanks, James

AU - Bhatia, Amina

AU - Greenwell, Cynthia

AU - Garcia, Nilda M.

AU - Lawson, Karla A.

AU - Motghare, Prasenjeet

AU - Letton, Robert W.

AU - Alder, Adam C.

PY - 2017/2/1

Y1 - 2017/2/1

N2 - 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 (< 18 years) 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.

AB - 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 (< 18 years) 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.

UR - http://www.scopus.com/inward/record.url?scp=84994417105&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84994417105&partnerID=8YFLogxK

U2 - 10.1016/j.jpedsurg.2016.09.002

DO - 10.1016/j.jpedsurg.2016.09.002

M3 - Article

VL - 52

SP - 345

EP - 348

JO - Journal of Pediatric Surgery

JF - Journal of Pediatric Surgery

SN - 0022-3468

IS - 2

ER -